Kevin Curley: How the sector can influence the future of the NHS

Our columnist finds out how charities are engaging with Sustainability and Transformation Plans

Sustainability and Transformation Plans are being produced by 44 partnerships all over England in response to the NHS Five Year Forward View, the 2014 document that set out a vision for the future of the health service. As someone who is sceptical about yet another health and social care “transformation project”, I thought it was time to find out what local voluntary sector leaders think about STPs and how they are engaging with them.

Neil Cleeveley, chief executive of Navca, the local infrastructure charity, tells me: “For NHS leaders, STPs are seen as the way to deliver the necessary transformation of services, so it’s crucial that local voluntary organisations are involved, helping people to have a say about their own local services. Areas such as Stockton and Northamptonshire show that good engagement with the voluntary sector is possible.”

David Pearson, director of adult social care, health and public protection at Nottinghamshire County Council and STP lead for Nottingham and Nottinghamshire, said in his response to feedback on its five-year draft plan: “With a significant funding gap, we need to think carefully about how we organise ourselves to provide the right care in the right place to maximise value for the public money we spend on local services.”

Acknowledging that a “funding gap” is driving the need for a fundamental change in services is strikingly honest, but is bound to bring sceptical responses. I therefore sought the views of David Smith, chief executive of Hull and East Yorkshire Mind, who has described previous change projects as “doing little more than creating photo opportunities and jobs for the perennial transformation consultants”.

This time I find him taking a more positive approach. “For once we have been able to pretty much set our own agenda,” he says. “When I sit around a table with people from across the Humber Coast and Vale STP Mental Health Group, it’s obvious how much frustration there is with the status quo and how much energy there is for doing things differently.”

Smith believes there is an opportunity to escape the limitations of historic agreements and relationships that have been barriers to change.

Smith has at least got at seat at the table that matters in his area. Maria Ward, network officer at Nottingham CVS, says the voluntary sector secured only three places on the STP advisory group in February after holding commissioning events attended by more than 80 voluntary organisations. An opportunity to influence the STP has now been opened up.

In Derbyshire, a completely different approach has been taken by Kim Harper, chief executive of Community Action Derby, and Vita Snowden, chief executive of Creative Carers. In April they published a “shadow STP” called Local Communities: Joined Up Care, which they want to see “merged” with the official draft STP. Snowden says: “We want a fresh approach where people’s needs are at the heart of everything, rather than a futile reliance on system changes driven by officials.”

The authors describe “common sense” community and self-care solutions, which they claim can lead to savings. It’s a challenging read and a clear demonstration that the local voluntary sector can influence the content of STPs where there is a good leadership.

Kevin Curley is a voluntary sector adviser

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RNIB’s Kevin Carey says unitary boards should be default model

Writing in a personal capacity for a series of essays published by the think tank NPC, he says the model of voluntary trustees does not work for bigger charities

Unitary boards should be the default model for major charity governance, according to Kevin Carey, chair of the sight-loss charity the RNIB.

Writing in a personal capacity in an essay published by the think tank NPC on Friday, Carey argues that large charities should move towards adopting unitary boards, where the non-executive members, the trustees, sit alongside executive staff members on the same board.

Carey says the existing model, in which voluntary trustees sit on a separate board with oversight of the senior leadership does not work for charities with annual incomes of more than £1m. “The bigger they are, the worse it is,” he writes.

He argues that most charities do not fail because they lack a governance code, a risk register and a trustee handbook, but because of trustee cowardice in which “nobody has the guts to say that the CEO is useless, the deficit is structural or, more widely, that the emperor has no clothes”.

Carey adds: “Charity law gives trustees all the responsibility and executive directors all the knowledge, power and capacity to obfuscate. This makes a nonsense of any call to adopt good governance.”

He says the “Victorian” split between amateur trustees providing oversight and strategy and professionals dealing with implementation is allowing directors to fob off the boards and could lead to bad implementation.

“I think the default for the governance of major charities should be unitary,” he writes.

“It helps avoid the farce of the executive team not telling and the non-executive board not knowing; the executive team doing all the crisis management and the non-executives turning up once a quarter to smile at a crisis averted or to pick up the pieces.”

But Carey says the process of applying to the Charity Commission to adopt a unitary board is currently an “unnecessarily complex and unpredictable process”.

He also argues that decisions about whether trustees should be paid should be devolved to the charities themselves, rather than being overseen by the regulator, saying unease about this issue stemmed from “the sector’s history of the ‘great and the good’ doling out benefits to the weak and the poor”.

He says: “Apart from the rank hypocrisy of paid charity commissioners ruling that charities can’t pay their trustees, there is no logical argument for a one-size-fits-all rule.”

And Carey says trustees should adopt a more business-like attitude to governance, particularly when it comes to mergers, calling for trustees to be legally required to demonstrate there is a good reason for rejecting merger proposals.

“The problem is, turkeys won’t vote for Christmas, and this is the overwhelming reason for rejected merger proposals in the sector,” he says.

“So the law needs to see that they behave in precisely the same way that commercial boards must when they are approached with merger proposals. For commerce, the main motivation is to maximise shareholder interest. For charities it should, legally, be consumer interest.”

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He also criticises the Charity Commission, the National Council for Voluntary Organisations, and the charity leaders body Acevo, as not fit for purpose, and calls for them to be scrapped in favour of a self-regulatory regime for major charities with smaller voluntary organisations operating under generic tax, civil and criminal law.

The essay is part of a collection of 16 published by NPC on Friday called Flipping The Narrative: Essays on Transformation from the Sector’s Boldest Voices.

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Movers: Kevin Clements is director of fundraising at the Animal Health Trust

Plus: Iain Heaton goes to Blue Cross; Janette O’Neill to retire from USPG; and Andy Moreman appointed chief executive of Young Devon

The Animal Health Trust has welcomed Kevin Clements as its new director of fundraising. He joined this month from St Nicholas Hospice Care, where he was director of fundraising and marketing and deputy chief executive.

The animal charity Blue Cross has appointed Iain Heaton as director of finance and resources. He joins in September from the Pony Club, where he has been working as director of finance and operations and latterly as interim chief executive.

Janette O’Neill, chief executive of the Anglican mission agency USPG, has announced that she is to retire after six years in the role. She was both the first woman and the first lay person to be appointed to the position.

Andy Moreman has been appointed chief executive of Young Devon, which supports vulnerable young people. He will join in September from the same role at the Christian publishing company CPO.

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