third sector

Anna Coleman and Julia Segar

A recent publication by the New Local Government Network (NLGN) looked at how local councils are preparing for the future and suggests depressingly that “there is simply no way that local government can reach 2018 let alone 2020 while still delivering the full range and quality of services currently on offer”(p6).

Simply put, we have an ageing population, with associated increasing demand for care services and draconian cuts in council budgets. The NLGN suggest we could be facing a future of “private affluence and public squalor”. However, it is not all doom and gloom. Perhaps austerity can be a strong stimulus for innovation? How would this work I hear you ask?

They suggest a new model being discussed around the country. The idea would be to mix technology, preventative investment, integration of council services with those of the NHS and others, alongside the creation of new partnerships between local government and local populations.

The NLGN report suggests three possible ‘landscapes’ for councils of the future. Firstly, a wasteland – a world of poorly prepared councils forced to cut services dramatically. Secondly, the wild meadow – councils provide core functions and rely on spontaneous public contributions to replace dwindling services. Finally, the common – the focus moves away from the council to places where it shares responsibility jointly with communities and businesses. This latter approach is seen as optimistic and would need to build on a strong social and voluntary economy.

This idea is timely for us as about a month ago Anna chaired, and Julia attended, a briefing event in the NW of England on Health and Wellbeing Boards (HWBs) and how (if at all) they were engaging with local voluntary organisations and local Healthwatch. Speakers at the event came from a local Healthwatch, a local overarching voluntary organisation and someone associated with Regional Voices. Speakers described their organisations and their relationships with their HWBs. They reflected on what could be done to improve these interactions to benefit all involved. So could we tap into some of these ideas for helping to build the idea of a common?

The official vision for HWBs from the Department of Health emphasised: joint local leadership between Clinical Commissioning Groups (CCGs) and local authorities; key roles for elected councillors, clinicians, and directors of public health, adults and children’s services; the enablement of greater local democratic legitimacy of commissioning decisions, and provision for opportunities for challenge, discussion, and the involvement of local representatives. However, HWBs have no formal powers, and their ability to influence others will depend upon their success in building relationships and interacting with other organisations locally. See our previous blog (Coleman 2014) for further detail on HWBs.

On paper, then, HWBs look like ideal forums for enabling the growth of both vision and action for building local commons. Speakers at the NW event, suggested that a shift in emphasis needs to take place before such a vision can begin to be realized. They argued that a tokenistic place on a HWB is of little value either to the HWB itself or to voluntary sector organisations. The voluntary sector together with Healthwatch, can provide valuable information about needs, concerns and available assets from a range of voices within a local community, with evidence varying between robust data to insightful patient stories (National Voices 2014). In Manchester alone, there are over 3000 voluntary organisations delivering a wide range of services to diverse groups. The estimated worth of the sector in 2012 was £477 million drawing on the work of over 94,000 volunteers (Dayson et al 2013). So HWBs should consider carefully who might sit on (or with) the HWB, and at what level (Board or sub-group) to represent the views of the voluntary sector and how these individuals should be chosen.

It was suggested that HWBs are missing a trick if they don’t engage effectively with local Healthwatch (who have a seat on HWBs) and voluntary organisations (who may be invited to sit on HWBs).These organisations have valuable knowledge, local intelligence and capacity at community level. The speakers indicated that very rigid structures and ways of working do not always work and that having a seat at the table does not guarantee that organisations are heeded. In order to develop new ideas and innovative solutions for complex local health and wellbeing needs, HWBs need to devote time and attention to voluntary organisations and to Healthwatch. In the current state of austerity sharing resources, skills and information is vital and good practice both locally and nationally.

This briefing event asserted the role of the voluntary sector in improving the health and wellbeing of local populations. The contributions that they could make in helping realise the landscape of the common is also clear. Step one on this path is to see, hear and listen to these organisations on HWBs.

Now read:

Anna and Julia’s article Joining it up? Health and Wellbeing Boards in English Local Governance: Evidence from Clinical Commissioning Groups and Shadow Health and Wellbeing Boards is published in Local Government Studies.

Anna Coleman is a Research Fellow in the HIPPO team (Health policy, politics and organisation groups), part of the Institute for Population Studies at the University of Manchester. HiPPO also constitutes, jointly with researchers from The London School of Hygiene and Tropical Medicine and the University of Kent, the Department of Health Policy Research Unit in Commissioning and the Healthcare System (PRUComm). PRUComm provides evidence to the Department of Health to inform the development of policy on all aspects of health-related commissioning.

Julia Segar is a qualitative researcher in the Centre for Primary Care at the University of Manchester. Her previous projects were concerned with telehealthcare and with changes in the healthcare system. Julia part of the Health, Policy, Politics and Organisation (HiPPO) research group within the Centre.

Disclaimer: The research for referenced paper is funded by the Department of Health. The views expressed are those of the researchers and not necessarily those of the Department of Health.

James Rees

Inlogov and TSRC recently held a stimulating and well attended seminar involving guests from University of Illinois at Chicago. It was a great opportunity to share knowledge on the role of third sector organisations in public services, and to compare the ways in which there are similarities facing TSOs in both the US and UK.

But as so often it begged many questions as well and I want to reflect a bit on both the state of what we know and what we ought to know about the third sector’s role in delivering public services (in the UK!).

When I talk to people about the research that I do, the usual response is “what on earth is the third sector?” followed by “do they really deliver public services?” I’ll come back to the first question but the second is certainly very interesting.

There is a very long history to the involvement of what we now call the third sector in meeting welfare needs and providing services. Many are aware of early charitable and philanthropic action in the 19^th century (Barnardo’s, RNIB and RSPCA for example); there was an explosion of mutual, co-operative and associations in the early industrial period; and before the dawn of the welfare state many health services were provided in voluntary hospitals that worked in partnership with local government.

Pete Alcock pointed out how these forms of the third sector had waxed and waned in response to political and economic change, leading right up to the 1980s Conservative interest in the third sector as alternative providers, the influence of New Public Management, and New Labour’s commitment to ‘partnership’ with the sector, written into a Compact.

In my discussion I suggested that it was useful to look at different levels or ‘strata’ of the third sector in relation to service delivery.

There are the big national charities (for example Barnardo’s, NSPCC, RNIB and the Salvation Army). It’s probably fair to say that the public perceive that these organisations rely on donations and fundraising, but they also hold very significant contracts to deliver services. For example Barnardo’s and Family Action run ‘Sure Start’ Childrens Centres. Action for Blind People, part of the RNIB Group, deliver a number of publically funded services to people with sight loss including schools, supported housing, and tailored health services within the NHS. This of course is only a tiny snapshot of what is by far the most visible part of the sector.

All of the mentioned organisations, and many more of varying sizes, large, medium and tiny, are involved in the Government’s controversial Work Programme, which aims to help benefit recipients into sustained employment. Our recent research drew attention to the difficulties charities were facing in terms of the strictures of the payments system, the lack of resources, and the prevalence of perverse ‘creaming and parking’ behaviour.

The work programme experience shows how public service delivery can be controversial and risky for charities, both financially and reputationally. But the costs are balanced by the opportunities contracts provide for charities to lobby government (where involvement can equal ‘insider status’ and credibility); and many charities argue it is consistent with their mission to bring their expertise to bear to improve services for their own client groups.

In my view there is a ‘missing middle’ as far the third sector and its role in public services is concerned. Missing only in the sense that we know less about it and there is a huge variety of experience so it is difficult to make generalisations about what is happening at this level.

Many organisations are much smaller than the ones mentioned above and tend to operate at the level of a region like the north-west, across a small number of local authorities, or even within a neighbourhood. They might have contracts with a local authority or a PCT (soon to be a CCG), and this part of the sector delivers a bewildering range of services.

We have been studying just these sorts of organisations as part of current research into public sector commissioning of the third sector. I have been struck firstly by the immense variety exhibited by organisations at this level, in terms of the types of services that they provide, their size and scope of operation, and seeming difference in their ethos, culture and degree of professionalism.

Secondly I have been struck by how vulnerable some seem to apparent threats in the current environment, most obviously loss of existing contracts and grants as a result of (mainly local authority) cuts, but also the possibility of competition from other TSOs and private sector organisations, and a wider sense of uncertainty, verging on fear.

Perhaps in some sense this is par for the course for the sector, and no organisation has a special right to exist. But I do wonder if we fully understand and value what might be lost if we start to lose these organisations in any great number, as they undoubtedly play an important role for many communities and individuals.

Finally, TSRC has done a great deal of research on organisations ‘below the radar’. Arguably again little is really known about how grassroots groups might interact with public services, enhance them, or what impact austerity might have on this vast ‘ecosystem’ of organisations. Much the same can be said about the important role of volunteers in public services. At the same time there is growing interest in how small community groups can be part of the co-production of public services.

Back to that first question: what on earth is the third sector? As soon as we start talking about different levels of the third sector, the huge diversity it contains, and the porous boundaries between in this case the grassroots and community sector, it begs the question of why we use the label ‘the third sector’. Are we dealing with a sector at all?

In an esoteric but influential paper in 1997, Perri 6 and Diana Leat argued forcefully that the sector had been ‘invented by committee’, in other words it was a social construction that suited the interests of some key political interests and society might have been better off without this invented sector and an obsession with the ‘politics of organizational form’. Pete Alcock takes a softer line, suggesting that the sector is held together in a ‘strategic unity’ in which tensions and disparities are sometimes played down in order strengthen the sector’s hand in negotiations with the state. These might seem like questions designed to keep academics in jobs, but it is interesting that people in the sector seem to keep asking similar ones as well: what makes our sector distinctive? What are our unique values and ways of working?

The seminar was interesting because even in the short amount of time we had available participants began to pose some really hard questions for academic research. I hope we can return to many of these:

What is the ‘right’ role for the state in providing public services?
Is the third sector just a foil for ongoing privatisation of the public sector and wider public realm?
Is the third sector doomed to be under-resourced, vulnerable and ‘under-professionalised’? Or can innovations like social finance and social impact bonds make a revolutionary difference?

James Rees is a Research Fellow at the Third Sector Research Centre at the University of Birmingham. His recent research concentrates on transformations in UK public services including the role of the third sector, but his longer term interests have been in the governance of urban and regional governance, with a particular focus on the politics of city-regionalism; critical perspectives on urban housing market restructuring and housing policy; and more broadly on issues in urban regeneration, neighbourhoods and community. Follow him on Twitter: @jamesrees_tsrc .

INLOGOV Blog

The Institute of Local Government Studies, University of Birmingham

The role of the third sector in delivering public services: what we know and what we’d like to know