Memorandum from fpa
fpa welcomes the Public Administration
Select Committee's inquiry into the role of the third sector in
providing services directly to the public on behalf of the Government.
We provide a comprehensive information service to the public and
to professionals that is funded by the Department of Health. We
also provide community-based services, some of which are funded
by local authorities. We have drawn on our experience of providing
these services to inform the comments below. A full overview of
fpa's information service is provided at the end of this
submission.
1. PROVISION
OF SERVICES
AT A
NATIONAL LEVEL
1.1 The Government agenda has increasingly
moved towards devolving powers of commissioning and funding to
a more local level, either through local authorities or individual
Primary Care Trusts. While in many cases allowing greater local
flexibility is to be welcomed, there are some services which are
better provided on a national basis.
1.2 In particular cases, provision of services
at a national level has clear benefits. The sexual health direct
national helpline, provided by fpa, answers around
60,000 enquiries a year. The helpline is staffed by highly trained
advisors who use their own expertise to respond to queries, rather
than depending on scripts. In addition, the information provided
is accurate, up to date and confidential. If commissioning was
devolved to a local level, very few local authorities would be
willing to support a national helpline. However, the expertise
would not be available to provide a local service to replace it,
so the service would be lost completely.
1.3 Provision of services at a national
level avoids duplication of effort. For example, the current portfolio
of sexual health direct leaflets, provided through fpa's
information service comprises almost 30 different leaflets available
free of charge from Health Promotion Units throughout England.
If the system were to be localised, some authorities would choose
to continue to purchase these leaflets but others would decide
to produce their own. This would result in the loss of the rigorous
quality assurance processes that are currently in place. In some
areas leaflets would not be made available at all, effectively
cutting people off from a crucial source of information about
sexual health.
1.4 Economies of scale are also created
through the provision of national services. This is the case for
example with the printing and distribution of the portfolio of
sexual health direct leaflets. More local commissioning
of services such as these would be likely to increase costs for
local authorities and ultimately for tax payers. The quality assurance
mechanisms and rigorous consumer testing that fpa uses
would also be lost.
1.5 When funding is devolved to a local
level, it is vital that mechanisms are in place to ensure that
it is allocated to its intended purposes. It is important that
there is accountability for how public money is spent at a local
level to ensure that service provision is adequate.
1.6 Increasing devolution of funding could
also create difficulties if the size of grants available is reduced.
Funders may face a choice between offering a small number of large
grants or a larger number of small grants. This will have a significant
impact on the scope of the funding as well as on the sustainability
of the projects that can be provided through the voluntary sector.
2. INVESTMENT
IN SERVICES
FROM THE
VOLUNTARY AND
COMMUNITY SECTOR
2.1 Many voluntary and community sector
organisations have years of experience of working in a specialist
field and have created a large body of knowledge and expertise
and in many cases services are provided by specialist staff. This
expertise would be lost if services were transferred to other
providers or commissioning arrangements were fragmented. Once
this intellectual capital has been lost, it is unlikely to be
developed again.
2.2 In many cases, the involvement of a
voluntary organisation in the provision of a service is seen as
a mark of authority, because of the expertise and independence
the organisation is known to have. The quality of services often
depends on the reputation of these organisations, which has been
built up over many years.
2.3 Many services provided by voluntary
and community sector organisations are focused on specialised
areas, where the organisations have developed expertise. Local
commissioners of services may not have the level of understanding
necessary to commission services effectively. There is a risk
that, if such services were to be put to open tender, the bid
with the lowest price would not have adequate levels of expertise
to service the contract fully. This would damage the quality of
the service provided to members of the public as well as risking
the expertise that voluntary organisations have developed.
2.4 The way that the voluntary sector is
funded to provide services can have an impact on its sustainability.
Short-term funding for projects can lead to staff with particular
expertise leaving to find a job with more security or mean that
the expertise is lost if a project cannot secure longer term ongoing
funding.
2.5 There is also a risk that organisations
alter their priorities in order to secure funding. In some cases
the criteria that must be met to receive funding mean that it
may not be possible to access funding for a need that has been
identified by the organisation. The voluntary sector is faced
with a choice between securing funding or sticking to the priorities
they have identified.
3. THE NATURE
OF THE
SERVICES PROVIDED
3.1 Voluntary organisations often work in
areas that are considered to be difficult or sensitive and are
able to provide a point of view that is not always represented
through mainstream processes. For example, the stigma and embarrassment
that still surrounds issues around sex, contraception, sexually
transmitted infections and abortion means that it is difficult
to get a service user perspective on the provision of these services.
Through the sexual health direct national helpline, fpa
has daily contact with service users, which provides us with
an overview of consumer concerns about sexual health issues, which
we are able to share with professionals and policy makers and
which informs the content of the information resources we produce.
3.2 Voluntary and community organisations
are well-placed to provide comprehensive services with a highly
experienced and dedicated staff. Altering the arrangements for
the provision of services could lead to fragmentation which would
reduce the efficiency of service provision and result in a loss
of consistency.
3.3 Some of the services provided by the
voluntary sector have a specific preventative focus, which is
not provided by other services. These preventative services help
to save money that would be spent later by public services such
as the National Health Service or the prison service. For example,
some of fpa's community based sex and relationships programmes
are specifically aimed at supporting vulnerable young people to
make informed choices about their sexual health, which supports
wider efforts to reduce rates of under-18 conceptions, unintended
pregnancies and sexually transmitted infections.
4. CONCLUSION
4.1 The voluntary and community sector has
a vital role to play in providing services directly to the public
on behalf of the Government, often in areas that are considered
to be difficult or sensitive. Organisations have developed in-depth
knowledge and expertise over many years, which they use to inform
and support the services they provide.
4.2 Changes to commissioning arrangements,
particularly the move towards increased local decision-making,
could put this expertise and the future of these organisations
in danger.
4.3 There is also a risk that members of
the public will be offered reduced services and that the quality
of services will be diminished if the expertise of the national
specialist voluntary sector is lost.
4.4 The knowledge and intellectual capital
that voluntary organisations have invested in service provision
in a variety of sectors should not be put at risk for short term
financial gains.
4.5 In addition, it is vital that the funding
mechanisms for the voluntary sector do not compromise organisations'
priorities. Criteria for funding applications should not divert
organisations from tackling the issues they have identified through
their work.
5. FPA INFORMATION
SERVICE
fpa provides a comprehensive national
information service, sexual health direct, which is funded by
the Department of Health. This service has a number of components:
— Leaflets on contraception, abortion
and sexually transmitted infections.
— Work with the consumer and professional
press to ensure that articles about sexual health are accurate.
— Information for professionals.
— Advice to professionals about consumer
needs.
5.1 Helpline
The helpline is a specialist service that complements
more generalist resources such as NHS Direct and Sexwise. It is
used by both the public and professionals and answers about 60,000
enquiries a year. It is staffed by highly trained advisors, many
of whom have a background in sexual health services, who are able
to use their own knowledge and expertise to respond to enquiries
rather than relying on scripts.
5.2 Leaflets
Good practice guidance specifies that people
seeking professional advice on sexual health should be provided
with written information to which they can refer in the future.
The sexual health direct portfolio currently comprises
almost 30 different leaflets and further titles will be added
during 2007. In total, we distribute 8 million of these leaflets
each year. The contents of the leaflets are informed by the questions
commonly asked by callers to the helpline and they are all checked
by key professionals in the field. In addition, their style, format
and content have been consumer tested.
5.3 Consumer and professional press
On a daily basis, fpa talks to journalists
who are writing feature articles for newspapers and magazines
about sexual health topics. These articles are a major source
of information for the public and it is vital that the information
they contain is correct. Journalists contact us because they know
that we are able to provide a speedy, accurate and clear response
to their questions.
We undertake similar work for journals for professionals,
such as general practitioners, nurses and pharmacists, who are
not sexual health specialists, but who provide information and
advice about sexual health.
5.4 Information for professionals
We produce a quarterly briefing on the latest
developments in sexual health which is distributed to a range
of professionals. Professionals can also obtain information from
our Library service.
5.5 Website
fpa's website has details of clinics
providing sexual health services and this part of the website
receives in excess of 650,000 queries a year. The website also
provides information about all aspects of sexual health, which
is used extensively by the public, professionals and the media.
5.6 Advice to professionals about consumer
needs
Our extensive contact with service users provides
us with an overview of consumer concerns about sexual health issues.
This enables us to represent consumer views to professional bodies
and other organisations in a field where it is often difficult
to obtain a user perspective.
Without central funding it would be impossible
to sustain this service, because although some local areas would
continue to purchase leaflets, very few would be willing to support
a national helpline or the other aspects of the national programme.
It is probable that some areas would decide to produce or commission
their own leaflets. Economies of scale would be lost as would
our rigorous quality assurance processes.
February 2007
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