Letters: NHS privatisation is slipping under the radar

Posted by Society: Voluntary sector | guardian.co.uk on July 21, 2011 Comments Off

So much attention has been paid to the phone-hacking scandal that the NHS reforms are being allowed to slip by almost unnoticed. In your article (Lansley opens £1bn of NHS services to private companies and charities, 20 July), an example is given of possible savings in treating chronic leg wounds, where the NHS apparently pays out £18,000 over four years in each case, while Wound Healing Centre treated patients successfully for £720. This seemingly innocuous statement, promising great savings, hides a kind of purposeful deceit. Why should anybody with a "chronic" complaint expect a cure? I'm a glaucoma sufferer; I will never be cured, but the treatment makes a staggering difference in my quality of life. The NHS was blamed for not curing chronic conditions, the private clinic was praised for offering cheap treatment. Without clinical reference, this statistic is misleading at best. The idea of a heart rhythm being tested over the phone, saving bothersome visits to a cardiologist, where information from an ECG can save lives, is more dishonest. Maybe the next time Andrew Lansley has a headache, he could use his heart-monitoring telephone to bash himself over the head until the pain recedes.

Nicholas Stoker

Newcastle upon Tyne

• Your report describes the process of opening up NHS services to competition as intended to lead to better services and greater patient choice. That's not how it seems to be working out in my area in the field of talking therapies. I am a member of a therapy group run by Hertfordshire Partnership NHS Foundation Trust. We have recently learned that the trust intends to withdraw from providing any form of group therapy directly by June 2012, with ill-defined plans to commission the charity Mind to provide an alternative service. This initiative is still being worked out, but it appears certain that the new service will have much less funding and provide less support by therapists than we have had up to now. We also hear that in existing projects run by Mind they charge for services that would be free under the NHS.

This policy has been carried through without any consultation with us "service users". It will amount to privatisation, reduce choice and worsen services. The local PCTs might have had something to say about all this, but they have been in the throes of reorganisation for the last year, with little attention to spare for such issues. Is this the way the NHS is going?

Andrew Barton

Watford, Hertfordshire

• All Andrew Lansley's ideas for the provision of NHS services by commercial organisations could equally well be delivered by the NHS itself. Such provision would be more coherent as activities would be linked to other treatments patients may need. Lansley's proposals show no evident deviation from the prospect of creeping privatisation of the NHS.

John Chubb

Cheltenham, Gloucestershire

NHSHealthVoluntary sectorPublic services policyPrivatisationAndrew LansleyHealth policyguardian.co.uk

Charity cuts: big society and the ‘wrong volunteers’

Posted by Patrick Butler on July 21, 2011 Comments Off

Charities have been replacing salaried staff with unpaid interns and people who work for free. But it is still not enough to protect services from swingeing cuts

At last a piece of good news for the Big Society. In one area at least the numbers of people volunteering for charities is increasing. The bad news? They are the wrong kind of volunteers. The even worse news is that spending cuts mean some of the charities involved couldn't afford to support and train the volunteers, even if they wanted to.

This little nugget is buried in the London Voluntary Services Council (LVSC) "Big Squeeze" survey, published today. The survey report contains a commentary by Kirsty Palmer, chief executive Volunteer Centre Kensington and Chelsea. She reports an uplift of 40% in the number of people wanting to volunteer for charities in her local borough, one of London's wealthiest areas. But Palmer does not greet the news with unalloyed joy:

"Surely, then, this new army of volunteers who are coming forward are the answer to these organisations' prayers. Well... to put it bluntly, no. Over 80% of the volunteers registering with Volunteeer Centre K&C are looking for administrative work with a view to building experience to help them get a paid job. However, fewer than 20% of our organisations are looking for this kind of help. By and large, predictably, organisations are looking for help with fundraising, finance and business and most volunteers don't come ready armed with those skills."

An additional problem, points out Palmer, is that many local charities just don't have the resources to handle this surge of well-meaning but wrongly-skilled volunteer manpower. She doesn't want to sound churlish about it ("let's not wring our hands too much at being swamped with volunteers") but it is clear this big society "dividend" poses as many challenges as it does solutions.

As the LVSC report explains:

"Many respondents say they no longer have the resources to train and support volunteers nor meet their needs... Respondents suggest that the "Big Society" policy initiatives have led to a perception that the VCS is solely about volunteering and does not need investment in professional staff and infrastructure to underpin it."

One of many interesting trends spotted by the survey is the increasing importance for charities of volunteers and unpaid interns and "apprentices". As the cuts start to impact, organisations have made paid staff redundant, and kept services afloat by using people who work for free.

If you believe the cuts will return charities to a pre-lapsarian golden age where voluntarism is king, its halo untarnished by the stain of professionalism or state investment, then this looks like a good result. The problem is that many charities appear to have reached the point where not even outsourcing services to student interns is enough to keep them afloat.

As the survey report makes clear, the cuts are reaching a tipping point for some organisations: volunteers or no volunteers, cost-cutting only takes you only so far. Eventually, capacity, skills and organisational experience start to wither away or disappear entirely - at a time when the need for them is growing massively.

A wider look at the LVSC survey of 120 charities in London illustrates this: there's been a direct cuts-related dip in fortunes for most, with little prospect that things are going to get any easier. All are to some extent experiencing the three main elements of the "perfect storm" blowing through the charity sector: reduced income; rising demand; and higher costs.

Income, at least from public sector sources, is shrinking: 77% of charities surveyed expect* a decrease in funding in 2011-12, a significant change from the previous year when (pre-Coalition, and pre-Comprehensive Spending Review) 53% expected the purse strings to tighten. Of the 63 charities who gave a cuts figure, 23 were expecting budgets to shrink by over 50% (12 by over 90%), while 18 expected to see cuts of between 21% and 30%.

Asked whether demand for services had risen, 81% of respondents said that it had. This was again, a big increase on 2010, when the figure was 68%. Demand will soar again in 2011-12, reckoned 86% of respondents. Could they cope with that surge? Some 43% of charities said they hadn't even managed to meet rising service demands in 2010-11. Asked whether they were confident they could handle demand over the coming months, 77% said they were not.

How easy will it be to cut costs? The survey suggests there's a slight increase in the numbers of charities saying they will look into "collaboration" or merger with other organisations (63%). More are now considering sharing back office functions (31% against 16% the previous year). Fewer charities expect to make staff redundant (33% against 51%) - possibly because there is no more fat to cut. Fewer are taking on volunteers in 2011-12, notes the report, another sign, as I pointed out above, of shrinking capacity.

It may be that many charities are reaching the point where their services are simply becoming unsustainable, because cost-cutting cannot be taken any further. Over half said they closed services in 2010-11, while roughly the same number expect to close services during 2011-12.

And who is bearing the brunt? Charities providing advice and support on unemployment, housing, and benefits. Youth services, including toy libraries, playgrounds, and holiday play schemes. The unifying theme appears to be cuts to preventative services, the very category that ministers say they want to preserve investment in. The report quotes the Toyhouse Libraries Association of Tower Hamlets:

"Despite all the emphasis on early identification, intervention and support, it is exactly those preventative services that are being cut first."

* Why do charities say they merely "expect" funding to shrink this year? Astonishingly, because many charities had not, by the time of the survey in April 2011, heard whether or not they had secured council funding due to start in, yes, April 2011. LVSC told me this was not uncommon: indeed, some charities did not expect to hear whether they would receive funding from their local authority for this year until August or September - five months after the start of the financial year!

Public sector cutsCharitiesVoluntary sectorLocal governmentVolunteeringPatrick Butlerguardian.co.uk

Ken Loach documentary to get first screening after 40 years

Posted by Stephen Bates on July 21, 2011 Comments Off

Hour-long film made for Save the Children in 1969 will be shown as part of major retrospective at the British Film Institute

The veteran film director Ken Loach is used to having his works banned, but none have previously had to wait more than 40 years for a public showing.

His television documentaries on trade unions in the 1980s were pulled from broadcasting and his film Hidden Agenda found few cinemas willing to show it. In September, however, an hour-long documentary film that he made for the Save the Children charity in 1969 is finally to get an airing as part of a major retrospective at the British Film Institute (BFI).

The reasons for the ban remain obscure. It seems to have had something to do with the director's pugnacious take on race, class and charity in a capitalist society, or perhaps the quotation from Engels that prefaced what was supposed to be a celebration of the charity's 50th anniversary.

Save the Children has finally lifted its embargo. There are still legal problems to sort out, but the BFI is confident it will be screened before an audience as opposed to a handful of archivists on 1 September.

Loach said: "It is a good story, but I have been told to button my lip for a while longer." Speaking at the BFI, Loach was in reflective mood the day after the Murdochs' appearance before the Commons committee – "that gave a great deal of pleasure" – but unhappy with the MPs who questioned them: "So timid, so ill-prepared, they failed to land a punch ... I am not sure you could make a film about it at the moment though. It's the part they play in our society, over our means of communication ... our news is determined by someone with big quantities of money."

He also confirmed that he refused an OBE as far back as 1979, long before his films attacking the effects of Thatcherism. He said: "I didn't want anything to do with something that celebrates the British empire ... and when you look on the other members, it's not a group you want to join. They should publish a list of refuseniks every year, as well as acceptances – that would encourage others to turn it down too."

The BFI is planning to show all the director's feature films, documentaries and television dramas, stretching back to the seminal plays Up the Junction and Cathy Come Home, in the autumn to mark Loach's 75th birthday. The season will include a day-long showing of the 1975 BBC series Days of Hope, chronicling working class life from the first world war to the General Strike, which lasts a shade under seven hours, as well as more recent work such as The Wind That Shakes the Barley - Loach's Palme d'Or-winning take on the early 20th century struggle for Irish independence - Looking for Eric and Route Irish. There will be separate screenings in Bath, Sheffield, Belfast and Glasgow.

The director has just finished shooting his latest film, The Angels' Share. Meanwhile, he has donated his archives to the institute, including shooting scripts, notes, schedules, budgets, on-location photographs and notes on training kestrels made at the time of the shooting of what is still probably his best-known film, Kes, in 1969.

The 12 boxes of documents delivered to the institute include fan letters from Alan Bennett and Neil Kinnock as well as Channel 4's duty logs reporting abusive calls after the screening of a documentary during the miners' strike, and even an Eric Cantona mask used in Looking for Eric.

Asked what he thought of 3D films, Loach replied that he saw them as a distraction: "I rather deplored the move to colour from black and white."

Ken LoachBFIDocumentaryCharitiesVoluntary sectorStephen Batesguardian.co.uk

NHS services to be opened up to competition

Posted by Randeep Ramesh on July 19, 2011 Comments Off

More than £1bn of NHS services are to be opened to competition from private companies and charities, including wheelchair services for children

The government will open up more than £1bn of NHS services to competition from private companies and charities, the health secretary announced on Tuesday, raising fears it will lead to the privatisation of the health service.

In the first wave, beginning in April, eight NHS areas – including musculoskeletal services for back pain, adult hearing services in the community, wheelchair services for children, and primary care psychological therapies for adults – will be open for "competition on quality not price". If successful, the "any qualified provider" policy would from 2013 see non-NHS bodies allowed to deliver more complicated clinical services in maternity and "home chemotherapy".

Andrew Lansley – admitting that the government's initial plans for competition in the NHS were too ambitious, and stung by criticism from Steve Field, the senior doctor called in by David Cameron to review the reforms, that the proposals were "unworkable" – has slowed down the rollout of competition. The health secretary said his plans would now "enable patients to choose [providers] … where this will lead to better care".

Labour questioned the policy, which the shadow health secretary, John Healey, said was "not about giving more control to patients, but setting up a full-scale market".

His colleague Emily Thornberry, the party's health spokeswoman, added that "today is a good day to announce the policy because everyone is preoccupied with telephone hacking. [They] hope no one will notice it."

This theme was picked up on Twitter with a stream of comments about it "being a good day to bury bad news".

Critics warned of "huge dangers lurking in the plans".

The trade union Unison said: "Patients will be little more than consumers, as the NHS becomes a market-driven service, with profits first and patients second. And they could be left without the services they need as forward planning in the NHS becomes impossible."

A spokesman for the British Medical Association questioned "the assumption that increasing competition will always mean improving choice.

"The ultimate consequence of market failure in the NHS is the closure of services, restricting the choice of patients who would have wished to use them." The Department of Health dismissed these charges and argued the policy would benefit patients by bringing many services out of hospitals, which would make it easier to access healthcare.

As an example, the policy could lead to patients being able to walk into a retailer on the high street or a local GP's surgery for a blood test rather than being forced to go to hospital.

One of the new policy's aims is to promote innovation, highlighting the "Tony Blair example". Abnormal heart rhythms, such as those suffered by Tony Blair, no longer need the immediate attention of a cardiologist.

Instead, a concerned patient could be treated by using the telephone to measure the heart beats and give an instant diagnosis, followed by a call from a nurse advising on whether the patient needed to go to hospital or not.

There were also major savings that could be made, the department said. It cited the example of chronic leg wounds, where the NHS pays out £18,000 per patient over four years, often without curing them. One not-for-profit company – Wound Healing Centre in Sussex – treats patients successfully for £720.

Lansley's commissioning tsar, Dame Barbara Hakin, said the NHS must push ahead with the agenda to offer patients more choice despite financial challenges and a period of "significant transition".

The NHS must save £20bn over the next four years in efficiencies.

Labour disputed the gains, saying the policy was just a step towards privatisation.

Healey said: "The Tory-led government is pushing ahead with its wasteful and unnecessary NHS reorganisation, rather than focusing on improving patient care."

Care options

From April 2012 patients receiving one of eight types of community and mental health services in England will be able to be choose to access their care or support from a private health provider or voluntary or charitable organisation, not just the NHS.

• Services for back and neck pain.

• Adult hearing services in the community.

• Continence services (adults and children).

• Diagnostic tests closer to home.

• Wheelchair services (children).

• Podiatry (feet) services.

• Leg ulcer and wound healing.

• Talking Therapies (primary care psychological therapies, adults).

These represent about £1bn of the NHS's £110bn a year activity.

NHSHealthVoluntary sectorPrivatisationAndrew LansleyHealth policyRandeep Rameshguardian.co.uk

The big society needs a graduate volunteer squad

Posted by Society: Voluntary sector | guardian.co.uk on July 15, 2011 Comments Off

With graduate employment still lagging behind pre-credit crunch levels, is a charitable volunteer force the obvious solution?

I'm sure some hardline right-wingers would love to reintroduce conscription to solve the graduate unemployment challenge. But alas, subjecting today's liberal-minded, globally connected graduates to enforced discipline and physical rigour would achieve little more than a revolt.

Young people today are simply more savvy and would never agree to be part of something they cannot personally support. Today we live in a multicultural society where people fight for human equalities and battle with injustice. Yet paradoxically we are presented with the perfect opportunity to reintroduce a new form of voluntary national service.

Over the next few weeks therewill be tens of thousands of young, enthusiastic, often idealistic, clear-thinking graduates entering the job market. Burdened by student debt and brimming with youthful "can do" attitude, this army of talent is there to be tapped.

Unfortunately however, many will find themselves flipping burgers or stacking supermarket shelves. Why, I ask myself, when there are potentially thousands of internship opportunities across the charity and social enterprise sector? The only problem is that the most needy of these grassroots organisations can't afford to pay.

It would not be difficult to extend some of the existing, excellent internship brokerage systems to include a new, big society internship programme.

Just think about it. "Big society interns" could be a kind of cultural land army, helping Britain become more self-sufficient in a time of crisis. Here's how it could work:

1. Existing internship brokers could encourage social, voluntary and community enterprises to list their needs as they transition into this new era.

2. The community and voluntary service movement would be well placed to help them define those roles.

3. The public-sector service commissioners in health, social care and education could fund these six-month placements at 50% of minimum wage.

4. The department for work and pensions could top up to intern pay with the benefits they'd pay them if unemployed.

5. Things get done and we embed within tomorrow's workforce commercial awareness and social conscience.

So perhaps Kitchener's "your country needs you" message is relevant today. There is a war to be won and it's one most graduates will understand and want to fight. We are in a corner as a nation, with debt, poverty and an ageing population all present problems today's generation can relate to.

Why pay graduates benefits to do nothing when with a little imagination and planning, we could create opportunities for them to be paid to battle at the front line of what the government calls "big society"?

• Robert Ashton is a social entrepreneur, best selling business author and increasingly a Big Society troubleshooter

Graduate careersWork & careersVolunteeringCharitiesVoluntary sectorUnemploymentStudentsHigher educationGraduateAll sectorsguardian.co.uk

Charity cuts: the ‘avoidable destruction’ of homelessness services

Posted by Patrick Butler on July 15, 2011 Comments Off

A charity chief executive has attacked the 'arrogance' and 'recklessness' of politicians and the 'incompetence' of civil servants' over drastic cuts to housing support

Another roar of pain and anger from the homelessness charity sector. I've written before about the havoc wreaked on vital housing support provision by the cuts (here, here and here) and the likely consequences. Some charities have laid low and accepted their fate: others have spoken out powerfully and eloquently about the short-sightedness of the cuts, and the effects they will have on the vulnerable people they work with.

What follows falls firmly into the latter category. It concerns a piece written by Andrew Redfern, the chief executive of Framework, a Nottinghamshire-based charity, for the introduction to a report celebrating its 10th anniversary. It explains how far services for homeless and vulnerable people have come in the past decade, not least as a result of investment through the Supporting People programme, and how quickly those services will fall apart, now that funding stream has been savaged.

Framework provides housing, employment and health support to the most vulnerable people, an area of preventative welfare that has shown itself to be high impact, both in terms of the social outcomes it delivers, and its cost-effectiveness. As Redfern explains:

"We are about saving tenancies, preventing repossessions and bringing people off the streets. We are getting them into homes, treatment, training and work."

The cuts come, however, as it experiences increasing demand for services from its most vulnerable clients: victims of domestic violence, homeless people, care leavers, refugees, teenage parents, older people, people with mental illness or disability, and ex-offenders.

It's worth pointing out that Redfern is no defender of the status quo. In conversations I have had with him in the past he has spoken passionately of the need to be flexible, to innovate, to integrate services, big society-style, with communities (as Framework been doing for years), and to adjust, like any other business, social or otherwise, to economic realities.

Redfern is furious, however, at the barely-manageable speed, scale, and crudeness of the cuts. I suspect he speaks for many charities, across many sectors, when he writes:

"Much of what has been achieved is now under threat, Change is both inevitable and welcome but avoidable destruction is not."

The bitter irony is that the decision-makers who have overseen those cuts do not seem to disagree with Redfern about the importance of housing support: neither ministers - who exhort councils to invest in housing support (but do nothing to ensure it happens) - nor local authorities, who blame the government's War on Deficit for the (in many cases drastic) cuts they are making to services for the most vulnerable. So what has gone wrong? Redfern explains:

"[Supporting People] is being destroyed by the recklessness of politicians and the incompetence of civil servants. All three parties are implicated. Labour removed the ring-fence from Supporting People [budgets], ignoring much expert advice and many representations from providers and service users. The Coalition has cut the budget and re-allocated it as part of a general redistribution from poor areas to rich ones. With nothing to protect the programme's resources, the winners use the money for other purposes at local level while the losers cut services to the most vulnerable people."

He continues:

"The politicians and civil servants who are presiding over this destruction will no doubt cite the recession and associated public sector deficit as justification for their actions. They have no such defence. The decisions taken at central and local level about the future of Supporting People have little or nothing to do with the economy. They are unnecessary, ill-considered changes driven by arrogance and an unwillingness to listen."

Redfern says the effects of this avoidable destruction are already apparent, both in Nottingham (where the Labour-controlled city council has cut Supporting People budgets by 45%) and in the surrounding areas (where Tory-run Nottinghamshire county council has cut the budgets by 43%). A day centre for homeless people has closed, along with supported housing for young women and rough sleepers, while services dedicated to keeping vulnerable people in accomodation (and not in hospital, prison or on the streets) have been scaled down. He says:

"The reduction and closure of services is already having a visible impact. Informal street counts show an increase in rough sleeping over the past few months. Hostels are beginning to 'silt up' as people have nowhere to go, and more people are seeking immediate help by knocking on the doors of offices, churches and private dwellings... I am especially concerned about the loss of floating support capacity with its inevitable impact on levels of homelessness, rough sleeping, poverty, ill-health and crime."

Disproportionate cuts, targeted at the most vulnerable, he says, don't just affect those directly affected, but they increase the burden on the tax payer by shifting the risk onto expensive crisis provision in hospitals and the criminal justice system. We may save money now, but we will pay many times over in the future.

Framework has had to make tough decisions: between 140 and 190 posts are at risk as a result of the cuts to Supporting People budgets. Remaining staff have taken pay cuts of up to 10%, and holiday and sick pay entitlements have been trimmed. For all this, it remains optimistic about developing new services. For all the anger felt towards politicians, and the frustration at the cuts, there's a determination to survive and succeed. As Redfern says:

"We can hardly cease to care just because times are tough".

Public sector cutsLocal governmentHousingCommunitiesHomelessnessCharitiesVoluntary sectorPatrick Butlerguardian.co.uk

Disability cuts will have devastating consequences, says charity chief

Posted by Amelia Gentleman on July 13, 2011 Comments Off

The chief executive of disability charity Scope tells Amelia Gentleman that the government's not listening

Click here for more on this story

Richard Hawkes is no longer able to conceal his anger with the government as it goes ahead with a package of public service reforms and cuts that he feels will have "devastating consequences" on the lives of disabled people.

When he became chief executive of Scope 18 months ago, he was determined to ensure that one of the country's largest disability charities did not merely criticise policies; instead, he wanted to engage constructively with the government in order to promote positive solutions.

After a period of trying hard to ensure that the views of his charity and the people it represents were heard, Hawkes feels that he has not been successful. He is particularly disappointed with the response he has had from the disability minister, Maria Miller.

"I would say that the government has not been listening," he says. "Maria Miller does meet with disability charities, but I don't think she really understands a lot of the issues, I don't think she listens.

"What disabled people need at the moment is a minister for disabled people who is really fighting their corner, really understanding the issues that disabled people face, and acting as their champion in government. I don't think that's happening at the moment."

Care compromises

At the top of a list of looming problems, he cites the huge effect that local authority cuts will have on services for disabled people, particularly with the tightening of eligibility criteria, so that in some areas, only the more severely disabled will have access to state-funded support.

"Local authorities are being put in an unfortunate position of having to compromise on the quality of care that people receive, because the funding isn't there," says Hawkes.

He also points to the replacement of incapacity benefit with the new employment and support allowance, and the intense unease that has been caused by the ongoing reassessment of claimants using a much tougher test.

He lists the reform of disability living allowance (DLA), undertaken by the government so as to cut the total cost of the benefit by 20% and, as part of that reform, the decision to remove the "mobility component" for people living in residential care, which could lead to up to 80,000 disabled people who live in care homes no longer being able to fund trips outside the boundaries of their residential unit.

"The whole range of different proposals that are being put forward could have a really negative impact on the lives of people. We don't think [the government is] thinking things through properly," Hawkes warns. "The collective, cumulative impact of all the changes that are being introduced are hitting disabled people the hardest."

He questions whether the government is primarily motivated by the desire to reform outmoded benefits or whether the principal driver of change is an aspiration to cut costs.

On the DLA reform, he says: "Going back to the comprehensive spending review and the budget, [the government] announced they were going to make savings of 20% on DLA. How can you decide that [a reform] is going to save 20% in advance? I would think that this is driven by cost reductions, and that they have come up with a way of assessing people that will result in the cost savings they want to make."

This week, Hawkes is trying again to influence the government's decision-making with a detailed analysis of its proposals for a new test to determine who is eligible to receive the new personal independence payment, which will replace DLA in 2013. DLA was introduced in 1992 in recognition of the fact that daily life costs more if you are disabled; the new benefit will support those "who face the greatest challenges to taking part in everyday life".

Scope, working with the thinktank Demos, has come up with suggestions for a different way of identifying extra costs faced by disabled people, suggesting that rather than simply looking at people's medical impairments, the assessment should examine their housing arrangements, their ability to use public transport and the availability (or otherwise) of friends and neighbours to offer support.

He argues that "the highly medical assessment" proposed by the government, and under consideration in the welfare reform bill going through the Lords, will produce a "guesstimate" that will reveal little about how much more it costs a disabled person to live their life.

"We understand that there are a lot of things that need to be changed; DLA does need reform and we want to see more disabled people get into work," Hawkes says.

"We don't want to be the kind of organisation that says: 'Oh we don't like this; we don't like that,' but want to have something positive to say ourselves. We've been investing in research, looking hard at how we measure impact in a whole range of areas, so that as an organisation we've got more positive things to say.

"We have been raising concerns about the way that they will assess people for work and for DLA for over a year. We have been seeking to engage with the minister for disabled people. But we are not being engaged with or listened to."

Mobility benefit

Scope has campaigned particularly hard on the relatively small issue of the removal of the mobility component for people in residential homes, and has been concerned at the government's inconsistent response on this issue. Hawkes says the charity has counted nine different explanations provided by the government as to why the benefit is to be removed.

More broadly, he is concerned that the tone of the discussion about disability benefits has radically changed, with a creeping trend towards demonising claimants as "scroungers".

"There's too much of a focus on that, rather than on the huge numbers of disabled people who want to work, are able to work, but just need the support to be able to do it," Hawkes says.

He believes that the prime minister has not focused on the probable fallout from the changes that are being introduced.

"What you hear from David Cameron is that he empathises with disabled people, that he understands what it is like to have a disabled person in his family, that he really cares about society, and that he wouldn't want disabled people to be hit harder than anyone else.

"However, the reality is that the reforms that his government is overseeing are having that impact," Hawkes says.

"He is not as aware as he might be of the real impact on individual lives on a daily basis ... I would really like to believe that David Cameron would not want to be leading a government that was stopping people in residential care going out shopping and meeting their friends."

DisabilityPublic sector cutsSocial careCharitiesVoluntary sectorLocal governmentDavid CameronAmelia Gentlemanguardian.co.uk

There are limits to how much charities can measure their impact

Posted by Cathy Ashley on July 13, 2011 Comments Off

The trend for assessing the difference charities' work makes could force good causes to lose their focus, say Cathy Ashley and Dan Corry

Voluntary sector bodies increasingly have to evaluate their impact on outcomes and to try to work out how cost-effective they are – it is becoming harder for them to obtain funding otherwise. The government, in particular, seems to hope that this could be a pathway to many charities funding themselves through social impact bonds. But although some evaluation work is useful, our work together shows that limitations need to be recognised.

Family Rights Group (FRG) is a small NGO that through an advice line supports parents and families whose children are involved with or need social care services, or are at risk of going into care. The charity worked with FTI Consulting to try to assess its outcomes as part of the tendering process to run a helpline.

Working out the cost per intervention is pretty simple. FRG targets the most difficult cases, so its calls to its advice line are longer and its advisers more qualified and experienced than some other groups.

The value for money case involves considering whether the additional outcomes from such specialist support outweighs those extra costs. And that is tough to measure.

FRG has many aims – including improved family functioning. But when trying to prove value for money to the government, it is the public costs avoided that is important. For FRG, the key measure is how many children did not go into care who otherwise would have.

This is a major ask of any voluntary sector body. Ideally, control groups are needed – but that would almost involve deliberately refusing to help every other call and seeing whether there was a difference in outcomes. Such controlled experiments are virtually impossible in this area – and questionable ethically.

Instead, FRG had good data on the characteristics of people contacting the charity and the issues they were facing. This gave some feel of the probability of children who might go into care without the charity's support. FRG had also undertaken some follow-up surveys (a difficult task as this client group often moves around, changes contact details regularly and is not keen to talk).

Would all of those children involved with FRG have gone into care without the charity's support? Would the families have got advice from elsewhere, and what would that advice have achieved? In these areas, intelligent assumptions had sometimes to be made in conjunction with the advice of experts.

The savings made when preventing a child going into care are easy to calculate, but problematic. The literature does not take into account the public service savings made by improved health, let alone the higher future earnings that children who have not been in care command. We still had to make some assumptions about how long a child would have been in care without the intervention.

Putting all this together, we found that FRG was very good value for money – with a conservative estimate that for every £1 spent, the taxpayer saved £11.

FRG was successful in its helpline tender. But it is hard to say whether similar assumptions and methodologies were used by other NGOs.

It was useful that FRG had to think about what its outcomes were, how it achieved them and how to collect better data. But there is a limit to what this approach can achieve, and it can force NGOs to focus only on what is measurable. The trend for outcome-based approaches, contracts and finance might in fact help destroy good outcomes.

• Cathy Ashley is chief executive of Family Rights Group; Dan Corry is a director at FTI

New disability benefit test ‘driven by cuts’

Posted by Amelia Gentleman on July 12, 2011 Comments Off

Disability charities tell government that new medical test to assess eligibility for benefit will lead to vulnerable claimants losing out

Click here to read our interview with Scope's Richard Hawkes

Proposals for a new medical assessment, designed to work out who is eligible for a reformed disability benefit, are flawed and could lead to vulnerable claimants losing payments, leading disability charities have told the government.

In a private meeting with disability minister Maria Miller, campaigners set out their concerns over the test for the new personal independence payment (PIP), with many organisations anxious that reform is being driven by a pledge to cut 20% from the cost of the benefit.

The new test will be piloted over the summer on around 1,000 volunteers who currently claim disability living allowance (DLA), which will be replaced by PIP when it is introduced in 2013.

Like DLA, the new benefit is designed to help pay some of the extra costs that disabled people face – higher electricity bills or increased transport costs, for example. It is not means-tested will be paid regardless of whether someone is in work or not. Government documents suggest that the new benefit will be targeted on claimants most in need, prompting concern about whether people with less severe disabilities will no longer be eligible.

Scope, the charity that campaigns for people with cerebral palsy, argues that the medical test will reveal little about the extra costs confronting claimants. Richard Hawkes, chief executive of Scope, said: "DLA needs to be reformed – but the highly medical assessment proposed by the government will produce a 'guesstimate' that won't tell you anything about how much more it costs a disabled person to live their lives."

"PIP is in danger of being a poorly-targeted payment, which will see many disabled people, especially those with less complex impairments but high disability-related costs, losing out on vital financial support," he said.

The government last year promised to reduce working age expenditure on this benefit by 20% on the forecast expenditure for 2015/16, triggering suspicion among campaigners that the changes are motivated by the need to cut costs rather than to improve the way the benefit is distributed.

"How can you decide that [a reform] is going to save 20% in advance? I would think that this is driven by cost reductions, and that they have come up with a way of assessing people that will result in the cost savings they want to make," Hawkes said. He was not at the meeting, but the charity was represented by a colleague.

The Disability Alliance has calculated that as many as 600,000 people currently eligible for the lower rate of the benefit (around £19 a week) could find themselves no longer eligible if the new benefit is tilted towards helping those most in need, but the Department for Work and Pensions dismissed this calculation as "entirely speculative".

"It is too soon to say how many people will be affected by the introduction of PIP, as we are still developing the assessment which will determine entitlement to the benefit," the DWP said in a statement.

Neil Coyle, the Disability Alliance's director of policy, said that the government was "ignoring the potential devastating impact on their families".

"Our concern is that disabled people may experience significant hardship, exclusion and ill-health as a direct result of DLA cuts. But these concerns have gone unanswered in a year of discussion with DWP," he said.

Tom Pollard, policy officer with the mental health charity, Mind, said there was "clearly a raising of the threshold" in the new test. "They have been talking about focusing the payments on people with the greatest need. We are concerned that a lot of people who receive the low-rate DLA will find that they are not eligible for the new benefit and that will have a significant impact on their wellbeing and their finances."

A DWP impact assessment published by the government earlier this year stated that it was "likely that some disabled people with lesser barriers to leading independent lives will receive reduced support … in line with the policy aim to focus support on those with greatest barriers to leading full and active lives."

"There is no evidence that some disabled people no longer need DLA; there should be greater clarity from government on where they believe the current abuse or wastage is within the system or risk cutting support for people in genuine need," a Mencap document states.

Scope recommends that the government should take other, non-medical, factors into account when it assesses people's needs, such as claimants' housing conditions, their ability to use public transport and the availability of family and friends to help them.

Miller said reform was vital because the current system had no inbuilt way to regularly reassess people receiving DLA.

"This means there is no way of knowing for thousands of people on DLA if their condition has improved, or if it is worse and they actually need more support. Little wonder there are £600m of overpayments and £190m of underpayments," she said.

"That is why we are introducing the personal independence payment to make sure that disabled people who need extra help and support will get it, and ensure they can rely on it for years to come."

DisabilityPublic sector cutsSocial careCharitiesVoluntary sectorAmelia Gentlemanguardian.co.uk

Newcastle croquet park and St Helens folly in line for lottery cash

Posted by Martin Wainwright on July 12, 2011 Comments Off

'Good cause' lottery money will be used to renovate Tyneside's Exhibition Park and Merseyside's Victoria Park

The clack of croquet balls in Newcastle and a pond that was central to Lancashire's brief but eager craze for eating frogs' legs are among the latest targets of the UK's "good cause" lottery money.

More than £5m in grants is being handed over to the Tyneside city, and St Helens, in what is now Merseyside, to renovate two parks famous for bringing strange and wonderful forms of entertainment to northern England.

The £2.4m Newcastle grant will renovate Exhibition Park in the city centre, restoring the croquet pavilion. There will be no re-creation, however, of the vast two-thirds scale replica of the mediaeval Tyne bridge that was built in 1887 across a newly created lake to celebrate Queen Victoria's golden jubilee.

Other work on the park will include new wildlife havens on the fringes of the lake and extensions to its "bee highways". The highways, thanks to carefully chosen flowers, bumble-bee boxes and the designation of selected allotments as "bee gardens", encourage bees into the city. The park forms part of a network which also includes window boxes in the city centre and gardens going out into the suburbs. The park's beds, and croquet lawns, are watered twice a week by convicted offenders on community payback schemes.

The grant for St Helens, famous for glass-making and Beecham's laxative pills, will pay for restoration work at Victoria Park, formerly a private mansion in large grounds that was sold to the council and opened in 1886 as the industrial centre's first public park.

Its large pond beside a folly, which will both be renovated along with a walled garden and wildflower meadows, was involved in the craze for frog's legs that drew national attention in the 1850s.

It was triggered when a reporter from the Liverpool Daily Post was sent to investigate claims that boys were catching frogs from ponds in St Helens and selling them as food. His discovery of a small-scale industry, with the hindparts of dismembered frogs being bagged and distributed "in a very tradesman-like manner", was taken up widely. The young entrepreneurs told him that the frogs were "putten in the frying pan and they are gradely good".

Frogs will be protected rather than eaten in the £3m restoration which follows a £100,000 grant three years ago to help the local council draw up its renovation scheme. The successful follow-up will be studied by 10 councils which have received small development grants in the latest package. These total over £725,000 and recipients include Berwick-upon-Tweed, Canterbury and the landscaped amphitheatre in Durham where the first Miners' Gala was held in 1871.

Other grants announced include £2.4m for Walpole Park in Ealing, west London, £2.1m for Felixstowe's Seafront Gardens, and £335,000 to restore the Phillips Memorial Park at Godalming in Surrey. This was laid out in 1913 beside the river Wey in honour of Jack Phillips, chief wireless telegraphist on the Titanic, who tapped out emergency messages as the liner went down the year before.

The Heritage Lottery Fund's chief executive, Carole Souter, said grants would continue to be steered toward parks "which make such a difference to our daily lives". She said that lottery money had become an "essential part" of investment in the urban "lungs" at a time of spending cuts elsewhere.

Paul Bramhill, chief executive of parks charity GreenSpace, said: "Parks are essential for healthy, happy and strong communities; the benefits they bring are immense and are now beginning to be acknowledged. Now we must ensure they can continue to contribute so extensively to our environment and this can only be accomplished through continual recognition, reinvestment and sustainable management."

NewcastleNational LotteryCommunitiesVoluntary sectorCharitiesMartin Wainwrightguardian.co.uk
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