Is the whole really greater than the sum of its parts?

As someone involved in too many partnerships to list I really hope so!! Because if not we are all wasting our time.

LHP Priorities Plan 2014_15_Page_1

South Cambs LHP Priorities

It was this question that the South Cambs Local Health Partnership was trying to answer when it looked at what solutions and actions we could take to make a real difference to the revised priorities they have developed.

A long and animated discussion led to a number of completed pages of flipchart followed by the rest of the agenda.

If all that happens is that the flipchart gets either

  • A) rolled up and put away or
  • B) written up, rolled up and put away

Then I say let’s make this the last meeting of this group and we can all use our extra time to do something useful on our own.

HOWEVER if we can start to make links and join projects together; if we can share vital knowledge across networks that improves services; if we can complement the work of one partner with the work of others and provide a more joined up service - then let’s get on with it!

What this can not be is simply a South Cambs District Council responsibility, and as such for once I have come away from this meeting with an action, rather than simply attending, reminding people how great the voluntary and community sector is and how unrecognised the work they do is, and then coming back to the office.

My argument was that we do not know how much the sector does to address the priorities that have been set. As the recognition that prevention is cheaper than cure (see my blog prevention, prevention, prevention) gains traction I believe that the sector has to be recognised and funded for the work it does – even if this takes away from the shiny acute health sector and all their big hospitals and bigger budgets.

My problem is that I do not know what impact the sector has on the priorities, or any other priorities to be fair. I know what great work many groups do, but I know that only a fraction have links with CCVS. I know that many groups provide a service but that this may not be linked directly to a priority even if it addresses it. I know that I have to start putting more flesh to the bones of my belief in the work of the sector. CCVS does this through its annual survey as well as picking up on informal feedback but now I have a small project. I am going to look at one South Cambs village; I am going to look at listing the work of the sector in that village and then mapping that against the LHP priorities. I hope it will show me a healthy and vibrant community as I have picked the village I know the best, I also hope it will help me demonstrate the impact that small community organisations have and why they should be at the forefront of preventative services.

I will post an update once I have done some work :)

Mental health is more than just a health issue

anxiety

As Mental Health Awareness Week draws to a close it seems fitting to highlight how this topic is rising up the agenda of a number of the community safety and crime partnerships CCVS attend.

Having recently attended the Community Safety Partnerships for both Cambridge and Fenland, and the Police and Crime Partnership meeting I am struck by the increasing issues raised around mental health and how it affects victims and perpetrators of crime. More and more the Police and other partners have recognised that the mental health of those that they are coming into contact with is a contributory factor to the committing of crimes and something that affects many victims.

There is a real desire to examine this issue and work out what can be done to prevent crime and to support victims and perpetrators to address any mental health issues. The new Cambridge City Community Safety Plan has a strategic objective to

“To understand the impact of mental health, alcohol and drug misuse on violent crime and antisocial behaviour”

The growing recognition that mental health is an issue and that reducing offending means looking at, and addressing, the underlying issues that people have has been recognised and the partnership recognises that it needs to find out more about this to develop effective strategies can only be welcomed.

In Fenland whilst there is no mention of mental health directly there is a strong focus on Anti-Social Behaviour and problems caused by alcohol. It is recognised that mental health problems have an impact on both these areas and that they need to be addressed.

Significantly the Police and Crime Commissioner has identified Mental Health as a priority area and will be bringing his influence to bear to look at how the system of dealing with mental health across the county can be improved with a view to reducing offending. The county has effective partnership structures in place around domestic violence that involve many agencies working together, this is overseen by a Domestic Violence Board who can ensure parity of service across the county and ensure that organisations are working together. The need for a similar board for mental health, along with the funding and partnerships to make a real difference seems to be paramount. So over to Sir Graham to make it happen!

As far as the voluntary sector goes there are numerous organisations working with and supporting those with mental health issues, reductions in funding to the NHS and increasing thresholds to get people into the clinical mental health system are putting pressure on many services. It is vitally important that everyone gets the support, treatment and information they need in an appropriate way. It is only a truly person centred and joined up system that will bring about real change for the individuals affected directly and indirectly by mental health issues; by doing this we will be able to reduce offending and create safer communities.

If you work in the mental health field please let us know your thoughts, we are looking at what we as a sector need to do in order to start influencing the agenda and providing services that work towards a common goal.

The search for someone to provide Older Peoples services continues

The consultation on the Older People’s Programme dominated the latest meeting of the Fenland Health and Wellbeing Partnership. And so it should it my opinion.

This is the biggest change in the way that health services are delivered in the county for a long time, and Cambridgeshire and Peterborough CCG are leading the way nationally in commissioning such a big piece of work. So the first thing to say is – have your say – check out the consultation website and encourage all those you work with to do the same. Spoiler alert – this page is quite long as is the consultation so it is not particularly user-friendly.

I guess for me there are three questions about this.

The first is what will the impact of the consultation be, especially the first question that asks

“On page 11 of the consultation document, Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) explains the reasons behind these changes. Please can you rate on the scale below how supportive you are of these reasons for changes?”

If everyone strongly disagrees will they not go ahead with the process? There was a hint at the meeting that this project could still be stopped if the prospective suppliers did not meet standards etc. So could people power really make a difference?

The second question I have is how this all adds up for services, for those using them and for those proving them. In effect the contractors are being asked to provide comparable services for less money. I am sure that there are efficiencies to be made in the current system that contractors could exploit to drive costs down, but introducing an extra layer of monitoring and a whole new infrastructure will surely cost so will services remain the same, will standards really improve and can we be assured that those delivering services on the ground continue to have the same salaries and benefits as they currently have. As those that know me will attest I am not a financial genius but I cannot see how these companies can deliver the same services for less money, and that overall that this way of working will save the NHS and us significant amounts of money.

My third question is where do the Voluntary and Community sector sit in this process? The consultation document talks a lot about community services and even has a section on the voluntary sector that states

“We believe that the use of the voluntary sector is very important in supporting independence and healthy living. One of the questions the CCG is asking bidders is how they will work with the voluntary sector. For bidders to answer this, we would expect them to make contact with voluntary organisations and to develop an understanding of what benefits the voluntary organisations can deliver to our patients.

As part of the procurement process a number of events have been held to provide an opportunity for voluntary sector organisations to meet with bidders to showcase the services they provide.

Bidders will be asked to explain how they will work with and fund services offered by the voluntary sector.”

So there you have it we should be expecting to receive funding – grants as well as commissions I hope. That said I don’t think that any of the shortlisted providers have been knocking on the door of CCVS to find out what the sector is doing and what they might like to do. If you have met with the shortlisted providers do let me know I would be interested to hear your experiences. CCVS will continue to push for a greater dialogue with all parties on the sectors role. We feel that it is essential that some guarantees are built into the contracts.

Getting back to the wider Fenland Health and Wellbeing Partnership I am pleased to say that future minutes and agendas will be published on the FDC website. I will post a link once they become available.

There continues to be a real feel of joined up working across some of the key priorities that the partnership have identified. Despite not getting funding to become a Local Alcohol Action Area the council are looking at how to reduce issues caused by alcohol both around health and crime and will be looking at the impact of a super strength campaign similar to the one underway in Ipswich. Similarly there is some great work underway about reducing Coronary Heart Disease and encouraging people to get a health test. More info on the FDC website.

Update the latest newsletter about the Older People’s Service is available here

Bring Unicorns Back to Our World: The Problem with Outcomes | Blue Avocado

Blue Avocado is a nonprofit online magazine for community nonprofits. Blue Avocado speaks for and from the people in community-based nonprofits. Nurturing the community organizations movement is Blue Avocado’s purpose. We publish every third Tuesday through an HTML newsletter delivered to more than 50,000 subscribers.

via Bring Unicorns Back to Our World: The Problem with Outcomes | Blue Avocado.

This is an american puplication but the outcomes issues are the same. From now on we should all have Bringing the Unicorns back to our world as our number one outcome! Roll on the lottery Unicon Fund

Why can’t the charitable sector realise ‘we are in it together’

I was going to title this entry ‘Why the voluntary sector sucks at thinking strategically’ but this was possibly a bit harsh. But I do think that there is a real problem, not with organisations thinking strategically, but with how organisations collectively look at the wider picture and what can be achieved by the sector by working together.

These thoughts were prompted by attending the South Cambridgeshire Crime and Disorder Reduction Partnership (CDRP). The papers for which are available here.

For years now collaboration, consortia, partnership working and any number of other variations of working together have been tried and tested by the sector with varying degrees of success. I realise we are all different, that we have different missions, visions and objectives BUT we must overcome this and find ways to think more strategically as a sector. We must also find ways in which we can collaborate together to look at some of the wider issues that statutory organisations are looking to address.

This meeting of the South Cambs CDRP looked at what had been achieved in the past year, and more importantly at what the priorities might be for the future. The bottom line is that this partnership is very good at the operational level work of bringing officers together to reduce crime and disorder. This is highlighted by South Cambs having the lowest number of crimes per 1000 residents of all the authorities it is compared against. This is down to great partnership working and great policing. So the priorities for the next year are – more of the same please. The partnership working is embedded and there will continue to be regular monitoring and meetings, this will be assisted by the use of some new IT systems. For the future there needs to be some additional work if the crime rate is going to be driven down, it will need a new approach that will have to concentrate on prevention as well as detection and punishment.

And it is here that the voluntary sector could be a key player, if we think strategically and work together. From projects that keep young people from offending or committing Anti-Social Behaviour, to projects to get villages to ‘look out for’ each other; from projects to make homes more secure, to projects that raise awareness of Domestic Violence and provide supportive ways to report this; the voluntary sector can deliver.

By looking at what we are doing, and where the gaps may be, by thinking creatively about the outcomes of our work and fitting these with priorities we could come up with a package of services that would make a real impact in preventing crime. This would give us the opportunity to look at funding for these services, especially where we could demonstrate the savings that could be made to the public purse by funding activities before problems occur. If we were really clever we could be linking different activities across not just crime and disorder but also health and wellbeing. So a project that helps people recognise drinking problems and change their behaviour not only reduces ASB and violent crime but also saves the health authorities money. A project that reduces distraction burglaries on elderly people by raising awareness and adding some simple security measures reduces crime, and also has potential savings as those affected by these burglaries often suffer from health issues brought on by stress and anxiety.

These are only simple examples that occur to me, I know that there are probably many more that I have not thought of. However I believe that it is not enough that we approach funders and statutory bodies individually with our projects, but that we work together to produce a collective set of proposals that together meet the priorities that are being set out by partnerships such as the CDRP. We should then work to get changes made to how things are funded and get politicians to justify why this type of project is not better at reducing spending than simply cutting services. There is no easy answer, and there will not be any simple outcomes that suddenly mean that the sector will find loads of new money, but we have a history of overcoming difficulties and changing mind-sets. If we work together we can change the way that funding is allocated, and if our statutory partners are going to continue to provide services in times of austerity they are going to have to realise that prevention is not only cheaper but better for communities and those living in them. So how do we do this given our already busy schedules and our conflicting visions? Well I will wait for you to tell me!

Prevention, Prevention, Prevention

Kirsty and Phill’s evangelism about location is nothing compared to health planners new-found fixation with prevention.

Fenland Health & Wellbeing Partnership 16 Jan 14

South Cambs Local Health Partnership 21 Jan 14

Attend any health meeting at the minute and the importance of reducing attendance at primary care and acute services (Doctors and Hospitals) is the consuming topic of conversation.It is not rocket science to work out that prevention is cheaper than cure. Stopping someone from falling is better for then and people’s budgets than dealing with a broken leg. Likewise keeping someone active both physically and mentally will help reduce their health problems and save the NHS money.

You may note that both these examples effect older people in a disproportionate way, and sometimes sitting in health meetings it seems only older people use their services. This may be because of the work happening in the county around older people’s procurement, it may be because of the aging population, or it may be because they use the health service more.

The Voluntary Sector has being doing prevention for years, often without realising it and certainly without measuring the savings made to the health and care providers. The lunch club that provides hot meals and activities for older people in a local village. The local history group that keeps people active and engaged in their community (although you do not have to be over 65 to be a member!), or on a larger scale the work of the U3A or organisations like Suffolk Circle. All these organisations and many many more like them provide help for people to stay healthy, to remain in their home and support them when they are in need. A great deal of it is not innovative or new, but it is tried and tested, and it does meet the need of local communities which is important in the more rural areas where public transport is non existent.

So when commissioners and planners are looking to increase funding for preventative work they need to look no further than what is already under their noses! The problems are that savings can be hard to prove, and they must understand that voluntary does not mean cheap or free. Money must be invested in groups and often these will not want to be scaled up, but with some work services could be replicated where they did not exist. At the same time funding has to be long term and ongoing not for short projects, and investment has to be made in support services for these groups  – Well what did you expect me to say :)

All this takes time to set up and put in place; mechanisms to evaluate projects that do not put an unrealistic burden on groups have to be found; needs and gaps in provision need to be identified; publicity campaigns are needed to recruit volunteers as well as let people know what is happening. This does not happen with a three-week deadline which is what the sector have been given with the Better Care Fund, but with planning, forethought, and the desire to take some risks the voluntary sector can deliver better services and support for older people and save the health system money.

Hate crime

“I hate you” is my 2 year olds most used phrase whenever they are asked to do something they don’t want to. She doesn’t understand the word, or really mean it, but it still has an effect. So being told this when it is meant, when the sentiments are backed by real venom, violence and vitriol has a significant and lasting impact.

Hate crime is a difficult topic for me to understand. I am white, male, middle (ish) class, heterosexual, employed and so probably constitute the least persecuted and hated type of person. But hate crime exists and even I have experienced it, all be it not directed at me, when out with friends who exhibit one of the protected characteristics. So is there really a problem in Cambridge, that City that I call home and that always seems so friendly and non threatening compared to some places I have lived. Unfortunately the answer is yes – there is a problem.

The Cambridge City Diversity Forum and Equality Panel held on the 18 November 2013 looked at the issue. (More info on the Diversity Forum can be found here and more on the Equality Panel here). I have linked these two meetings together as they have a natural cross-over and they happen one after the other.

At the Diversity Forum we heard from 3 speakers representing Cambridgeshire Human Rights and Equality Support Service (CHESS), Cambridgeshire Police, and the Crown Prosecution Service (CPS).

The first thing to pick up on is that there is a legal difference between a Hate Incident and a Hate Crime although the police are starting to record these in a way that ensures that incidents as well as crimes are reported and monitored. The presentation from CHESS gave definitions of these and they are shared by the Police. According to their figures 381 incidents were reported in 2011, the Police presentation gave some more up to date figures that broke down reports by type of crime, age, gender etc. What was stressed was the fact that there is massive under reporting of these types of incidents and that more needs to be done to encourage victims to report, because of those cases that get taken to the CPS over half are found guilty.

I came away believing that the police are taking this issue seriously, and that there is support out there for victims. There are many voluntary organisations working with people who may be affected by hate crime and many of these actively encourage people to report incidents and help them through the process. There is however a role for the rest of us as well. The government easy read guide ‘Challenge it, report it, stop it’ says

“If we keep quiet it can look as if we allow people to think and act badly towards other people. It also means that victims of hate crimes will think they are alone and that nobody cares. Everyone needs to show they will not accept thinking and acting badly towards other people.”

So when we hear people expressing views that could cause hurt through ignorance, malice or thoughtlessness we need to challenge it. We have to ensure that groups we work or volunteer in are open and have equalities policies that are understood and adhered to. And in my case I need to keep explaining to my two year old that they should not say “I hate you”

The government released a new national overview of hate crime in England and Wales. It can be found here. The figure on page 8 is telling, it shows the number of cases that are reported to the Police, that are detected and that get taken to court and successfully prosecuted.

The City Council Equality Panel is made up of officers, members and residents and is an independent body that supports the Council’s decision-making process. The role of the Panel is to discuss the Council’s equalities progress and support Council-led initiatives that play a leading role in the promotion of equalities and diversity. They heard a summary of the issues around Hate Crime as well as an update on the ‘Together for Families’ project run by the County Council, this included a presentation of a case study and an idea of the way that things would move forward in the future.

All the ‘resident’ members of the panel have a voluntary sector background and work in a number of different organisations, this means that the sector has a real voice and that the work carried out by the sector is recognised. They will be looking for a new member in the New Year and we will ensure that we let people know how to apply.

There is more that needs to be done to integrate the work of the sector with statutory bodies, but once again the City seems to be leading the way locally in trying to make this happen.