Memorandum from British Red Cross
SUMMARY
(i) The British Red Cross welcomes the opportunity to
contribute to the Committee's inquiry. We currently deliver services
under a total of 300 contracts from government, as a part of our
overall UK work. Our evidence draws from that experience, and
is not intended to speak for the Voluntary and Community Sector
(VCS) more widely.
(ii) We believe that the British Red Cross
is able to provide support to people which is distinctive, and
which is particularly valued by those we work with. Public sector
commissioning offers a potential opportunity to extend the reach
of these services for the benefit of those who need them.
(iii) Many of our services are delivered
by volunteers, and derive particular benefit from the time, flexibility
and quality of attention which volunteers are able to offer. However,
a number of our services are delivered by paid staff, or a mixture
of staff and volunteers, and we believe that the same ethos can
and should extend to all our work. We discuss some examples of
good practice in our submission.
(iv) Our experience suggests that to develop
and maintain this distinctive approach to public service delivery
it is vital that commissioners are clear just what capabilities
they wish to procure from the sector, and ensure that contracts
allow for these capabilities to be developed. This might entail,
for instance, ensuring that contracts are not unduly prescriptive
in setting out every aspect of what is to be delivered, that they
allow time for staff or volunteers to speak with clients and perhaps
identify additional needs, or that they give some flexibility
to VCS organisations to determine who may use the service and
open it up to others who need it.
(v) As a VCS provider we strive to develop
services which are flexible yet professional and accountable.
We believe that the contribution we can make is misconstrued,
however, if it is considered simply as a cheaper, like-for-like
replacement for state or private provision.
BACKGROUND ON
THE BRITISH
RED CROSS
1. The British Red Cross helps people in
crisis, whoever and wherever they are. We are part of a global
network that responds to conflicts, natural disasters and individual
emergencies. We enable vulnerable people in the UK and abroad
to prepare for and withstand emergencies in their own communities,
and when the crisis is over we help them to recover and move on
with their lives.
2. The British Red Cross is part of the
International Red Cross and Red Crescent Movement, which comprises:
2.1 The International Committee of the Red
Cross;
2.2 The International Federation of Red Cross
and Red Crescent Societies; and
2.3 183 National Red Cross and Red Crescent
Societies worldwide.
3. As a member of the Red Cross and Red
Crescent Movement, the British Red Cross is committed to, and
bound by, its Fundamental Principles. These are: humanity, impartiality,
neutrality, independence, voluntary service, unity and universality.
4. In the UK, the British Red Cross provides
a range of services to support people vulnerable to crisis:
4.1 Our care in the home service provides
short-term care and support in the home for people after an accident
or illness. This may be provided following a stay in hospital
or to prevent unnecessary hospital admissions.
4.2 We provide door-to-door transport for
people who cannot get about easily, restoring their freedom and
independence.
4.3 Our skin camouflage service teaches people
with disfiguring skin conditions and scars how to use prescribable
cover creams, helping them regain confidence and independence.
4.4 Our therapeutic care service helps people
in pain or suffering from stress to relax and regain their well-being
through a gentle hand and shoulder massage.
4.5 We provide short-term loans of medical
equipment, such as wheelchairs, for people with a disability or
illness and larger-scale Community Equipment Services.
4.6 We currently operate four care homes
in the UK.
5. As an auxiliary to the UK Government,
we work in support of the emergency services at major incidents,
and support people at fires and smaller emergencies. We provide
first aid services at public events and first aid training. In
addition, we deliver humanitarian education for young people,
support for refugees in destitution or after major evacuations,
and a global tracing and message service to reunite families in
collaboration with the other Federation members. Our services
are provided and supported by around 32,500 volunteers and approximately
3,000 staff across the UK.
6. Our work is funded from a variety of
sources, including charitable donations, government grants and
contracts, investments, shops and trading. Many of our services
are funded entirely from charitable funds. Income from competitive
government tenders mainly supports our care in the home services
along with some of our Transport and Escort services, and also
funds our Community Equipment Service. In 2006 we held 200 contracts,
which generated an income of around £20 million, which formed
approximately 10% of our total income for the year.
RESPONSE OF
THE BRITISH
RED CROSS
TO THE
INQUIRY
What are the benefits of contestability to the
users of public services?
7. Have services which have been transferred
to third sector organisations shown an improvement in quality?
7.1 Our experience is that there are aspects
of our services, including that delivered under contract, which
are distinctive and highly valued by service users, and which
differentiates our work from some public sector and private sector
provision. Some of these benefits and the value our service users
put upon them are illustrated below through an example from our
care in the home services. Developing new services and new contractual
relations with the public sector also raises new challenges, however,
and some of the learning from these is discussed in relation to
our Community Equipment Services.
Care in the Home
7.2 Research[103]
has found that VCS care in the home services, including those
provided by the British Red Cross, are effective in reducing the
sense of social isolation, which was repeatedly raised by service
users as their prime concern on leaving hospital. The quality
of attention and time given by volunteers was found to be crucial
to this. The social contact the service provides was valued as
much as the practical assistance, and furthermore the relationship
service users form with volunteers was seen as qualitatively different
to that with professional staff from health and social care services,
being more flexible and diverse in where it took place, and being
based simply upon kindness.
"Staff do what's needed but volunteers do
a bit more. K spends time with me and explains things, its uplifting
knowing she is going to come round and take me out ... [I'm] miserable
here on my own. Knowing someone's coming gives me the incentive
to wash my hair for example ... I cared for both my parents before
they died and also my brother so did not have time to make friends
and the friends that I had have all died... SSD don't do anything
for me—just talk about meals on wheels which I don't want".[104]
Community Equipment Service
7.3 The early experience of our developing
Community Equipment Services has been more varied, encompassing
both examples of good practice and some learning where problems
have been encountered.
7.4 Our service in Leicester, for example,
is very well established and had its tender renewed in 2004 after
market testing, and our Nottingham service has received extensive
praise from commissioners. Other services have experienced some
difficulties in developing performance, which highlights a number
of learning points. Firstly, setting up or taking over a service
is a significant undertaking, and it is important that commissioners
allow a reasonable period of time for a new provider to take over
a contract, if that service is to make a strong start. Secondly,
our experiences have highlighted the need for a strong, well managed
and constructive relationship between commissioner and VCS contractor.
In particular it is important that have a clear process for monitoring
and decision making, including a consistent point of contact for
the VCS. The relationship works best when both parties see it
as a partnership and work together to ensure successful outcomes.
For our part, the decision to enter this particular market has
also challenged the British Red Cross in developing and recruiting
a critical mass of quite specialist skills.
7.5 Our experience of operating Community
Equipment Services has also suggested positive opportunities for
ourselves as a VCS provider to develop the service, such as the
possibility to develop low-level assessment programmes to appropriately
manage demand, and the provision of staff who have had training
in first aid and our humanitarian principles, and who consider
their role as Red Cross personnel to extend beyond simply delivering
equipment.
8. Is loss of accountability a threat of commissioned
services?
8.1 The Red Cross is accountable to commissioners
(and through them to the public) under the terms, conditions and
reporting measures set out in the contract, in the same way as
any other VCS or private sector provider.
8.2 For all its services the British Red
Cross is accountable to the Charity Commission, and publishes
annual reports and quarterly financial reports. Of course, the
British Red Cross also has a direct moral responsibility to service
users to deliver the best service we can, as well as meeting a
range of legal obligations.[105]
We monitor our services through our developing service evaluation
and reporting procedures.
Is the third sector more likely to provide better
public services than the state or the private sector?
9. Is there evidence that where services are
provided by the third sector, that they are popular with those
who use them?
9.1 In recent years we have developed our
ability to monitor how our care in the home service and other
health and social care services are regarded by those who use
them, using service reporting indicators, focus groups and written
feedback from service users.
9.2 The collated national indicators typically
for our care in the home services, which make up the greatest
number of contract-funded services we offer, show very high levels
of satisfaction indeed: for January 2007, 97% of respondents asked
for their overall satisfaction with the service rated it as excellent
or good, of which 78% were excellent (of 4,136 respondents). In
order to better understand the range of views and needs which
underlie this very high figure we have conducted focus groups,
to examine what is helpful about the services, what could be improved,
and whether they are targeting those who need them most. Feedback
from focus groups and written comments suggests that the popularity
of these services is to a large extent grounded in the fact that
volunteers typically treat service users with dignity and respect
at a time when their morale and self-esteem is often low.
A woman who is a single parent had fallen and
broken her knee, meaning a nine day stay in hospital. She was
supported by British Red Cross (BRC) Home from Hospital volunteers
following her discharge home: "BRC volunteers came and did
my shopping for six weeks and also provided a wheelchair when
I first came out. I felt very supported by them. Felt a spark
between me and BRC team. We had a laugh. They are human. ... treated
me with dignity and respect. ... Initially I felt they were there
and gave me as much support as I needed. They understood that
I'm independent and felt frustrated. Without pushing me they encouraged
me to do things ... I was so impressed [by BRC] that I want to
become a volunteer myself".[106]
10. Is there evidence of demand for more services
to be provided by the third sector? If so, who from?
10.1 As suggested above, we have found that
our care in the home services are popular with those who use them.
This does not always translate straightforwardly into greater
demand for VCS provision from commissioners. It is our experience
that the onus initially falls upon Red Cross staff to develop
relationships with commissioners and to market our services, against
a background of low awareness and perhaps some caution about engaging
the voluntary sector. Once relationships have been developed and
a service is running, commissioners are typically keen to continue
working with us. Similarly with our Community Equipment Services,
where the relationship has worked well there has been the opportunity
to take forward further work and to develop the service. However,
cash shortages and disruption in Primary Care Trusts can sometimes
lead to contracts being withdrawn even where relationships are
established and benefits of the service are acknowledged.
11 Do public services provided by the third
sector more accurately reflect the changing needs of those that
use them?
11.1 We believe that close partnership between
government, the VCS and service users themselves has much to offer
in the development of responsive user-focussed services. Examples
of good practice within the British Red Cross include our Swansea
Supported Discharge Scheme, in which our services are commissioned
by the Welsh Assembly Government under the Supporting People programme.
The service supports people with insecure tenancies on discharge
from hospital, providing help not only with tenancy issues but
with other concurrent problems which are often not otherwise picked
up, such as the need for ongoing care or debt counselling perhaps,
or other support on the basis of the user's needs, and in doing
so unlocking resources which the client was not able to access
at the point of crisis.
A Swansea Supported Discharge client was referred
by Social Services on account of medical needs which required
a period of intensive support. It was established after a short
period of time that there were other issues which needed addressing
and which had previously been hidden, all related to alcohol,
and the client later confirmed that she was a functioning alcoholic.
This admission [resulted from] the Red Cross Support Worker building
up a huge amount of mutual respect and confidence: previously
no-one had spent any time listening and supporting her. The client
had been served an eviction notice due to the condition of her
property which had deteriorated over a short space of time, and
with the help and expertise of the support worker a flat was identified
and agreed close to the city centre. [The client] recognised that
she had an extremely chaotic lifestyle, which had resulted in
her young son being housed with an ex-partner, as she was at the
time incapable of providing a safe environment for him to live.
[Our staff were] amazed during the meeting how
much difference our support had made to her life. She explained
that just to have the crutch to lean on had given her the confidence
and energy to change her destructive lifestyle. She is currently
an active member of Alcoholics Anonymous self-help group amongst
others, as well as showing an interest in volunteering with the
British Red Cross. She is not drinking and has not relapsed since
October 2006 and has initiated contact with her son and is extremely
positive for the future.[107]
11.2 It is significant that our Swansea
staff were involved at the service design stage of this contract,
and helped to identify unmet need in partnership with Swansea
City Council as agents of the Welsh Assembly Government.
11.3 We are currently involved in a whole-system
project across the British Red Cross, to embed innovative, participative
approaches such as that shown in Swansea across our work more
generally.
Does commissioning benefit the third sector?
12. Will contractual relationships with the
state improve stability within the third sector?
12.1 The ability of the British Red Cross
to meet the needs of its users as described above is dependent
upon the stability of its income, of which funding from the government
sector is one element.
12.2 In principle, contracts may provide
a particularly stable basis for funding by setting out clear terms,
conditions and payment arrangements. However, there is long-standing
concern across the sector that government contracts do not typically
provide the stability they might do. In particular, we are concerned
about:
12.2.1 Full cost recovery: It is important
that third sector providers identify and charge for the full cost
of providing a service, and essential too that they are able to
recover this cost from contractors. Whilst this principle is accepted
by government,[108]
in practice this has not always been the case, and many government
funders remain reluctant to pay proportionate overhead costs within
a contract, which presents a long-term challenge to the sustainability
of those voluntary sector services.
12.2.2 Multi-annual contracts: It
remains common for VCS providers to be offered only rolling annual
contracts for their services. This hand-to-mouth approach damages
the stability of the sector. It has been widely accepted that
3-5 year contracts must be standard across the sector, and it
is vital that this consensus is translated into action. We welcome
the recent commitment by the Office of the Third Sector to training
commissioners, and its support for multi-year funding and implementing
full cost recovery across government.[109]
13. Will close involvement with service provision
prevent third sector organisations retaining the ability to be
critical of government?
13.1 Balancing a close relationship with
government and a commitment to independence is not new to the
British Red Cross: all Red Cross and Red Crescent national societies
have a long history of close and effective collaboration with
their national governments, and are auxiliary to their governments
in matters of humanitarian assistance. At the same time, all are
committed to the Movement's fundamental principles, which include
maintaining independence and neutrality in order to carry out
our work nationally and internationally.
14. Is there a risk that the service providers
will become increasingly bureaucratic?
14.1 As a large, national charity, we wish
to ensure that all our services are provided in a professional
and accountable manner, and do not believe there is any prima
facie reason why services under contract must be more bureaucratic
than others. However, in practice it is widely acknowledged that
different local funders such as Primary Care Trusts and Local
Authorities often have varying administrative arrangements and
different contractual requirements for similar services, or even
(in the case of joint funding) for the same service. This significantly
and unnecessarily increases the degree of bureaucracy involved.
We have discussed this issue with the National Audit Office who
we understand will report to relevant government departments including
the Office of the Third Sector and HM Treasury.
15. Is there a risk that third sector organisations
will lose their independence, their identity or their distinctive
ethos?
15.1 The British Red Cross, like other charities,
has always needed to ensure that it pursues its core aims, ethos
and mission without undue influence from its funders—be
they government, trusts, major donors or the public. Where the
funder is a government body, contracts should in principle be
a helpful tool in managing this relationship, as they provide
a means to set out clearly what each party expects to gain and
to deliver. As we have suggested above, ensuring that the ethos
and particular contribution of the sector is harnessed and developed
requires that government commissioners are clear what distinctive
capabilities they wish to procure from the sector, and ensure
that contracts allow for these capabilities to be developed. This
might entail, for instance, ensuring that contracts are not unduly
prescriptive in setting out every aspect of what is to be delivered,
that they allow time for staff or volunteers to speak with clients
and perhaps identify additional needs, or that they give some
flexibility to VCS organisations to determine who may use the
service and open it up to others who need it.
16. Might the third sector become polarised
between large service providing organisations and more radical
groups? If so, would this matter?
16.1 Whilst we can only give evidence based
on our own experience, we understand that many smaller charities
are less able to take on substantial contracts, and understand
the importance of a range of funding mechanisms, including grants,
being available to support diversity within the sector.
What are the financial implications of providing
services through the third sector compared with directly provided
state services?
Are the costs and benefits to the state the same
when commissioned from the third and private sectors?
17. We are not able to provide an across-the-board
comparison with the cost and benefits of state run or privately
run services, but it should not be assumed that third sector services
will be either a direct equivalent nor a cheaper replacement for
state or private provision.
18. We are committed to delivering services
which are professional, accountable and fit for purpose, and these
are not necessarily cheap to provide. Whilst Red Cross services
are often (though by no means always) delivered by volunteers,
for whose time we do not charge, there are considerable costs
involved in recruiting, training and supporting volunteers, providing
professional management, equipment and transport, as well as paying
expenses and costing in overheads.
19. We believe these efforts are worthwhile
and that we can provide something over and above what state and
private sector organisations offer. On this basis we believe that
fostering an environment that supports the sector can lead to
tangible benefits to government, to the third sector and—most
importantly—to the people who benefit from our work.
February 2007
103 Making a Difference Through Volunteering:
The impact of volunteers who support and care for people in the
home. CSV, Help the Aged & British Red Cross, 2006. Back
104
Making a Difference Through Volunteering p 27. Back
105
Such as Operations and Lifting Equipment Regulations (LOLER)
and Portable Appliance Testing (PAT) standards for our community
equipment and medical loan services, and statutory care standards
for our care homes. Back
106
Making a Difference Through Volunteering p 50. Back
107
Debriefing from Swansea Supported Discharge Scheme, December
2006. Back
108
"Funders should recognise that it is legitimate for providers
to include the relevant element of overheads in their cost estimates
for providing a given service under service agreement or contract".
The Role of the Voluntary and Community Sector in Service Delivery
A Cross Cutting Review HM Treasury, 2002, p 40. Back
109
Partnership in Public Services: An action plan for third
sector involvement, Office of the Third Sector, December 2006. Back
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