Whose tune are you singing to? The community’s or the funders?

Social Action for Health (SAfH) is a highly successful, long-established community development charity running a range of projects to “increase local people’s active participation in improving their own health and well-being, tackling barriers, finding solutions”. SAFH works in East and South East London with a yearly budget of around £1 and a half million.

This story is about SAfH’s refusal to bid when Social Services re-commissioned one of its established projects. It illustrates the need to:

• be clear about, and hold on to, our values and ways of working
• change the way commissioners work, and get them to understand more about the voluntary and community sector

The story also shows

• what enables an organisation to say “no” to a powerful local funder and still survive
• the consequences of saying ‘no” for the organisation and the people they work with
• the value of a community development approach to work in the mental health field

This story is based on discussion with Elizabeth Bayliss (SAfH director) and Joe Walker (SUN Development Manager), and direct quotations come from them.

SAFH and the Mental Health Service User Network (SUN)

The SUN as it was

SUN is a network of 21 mental health service user groups in Tower Hamlets operating through a user-led steering group funded by Tower Hamlets Social Services. The SUN groups are diverse, catering for African- Caribbean, Somali, Bengali, White British and White European participants.

When Joe started working with the SUN in April 2005, he found what he describes as a “dead” network. Individual groups were “stuck in mental health support group mode”: participants commonly lived through a repeated cycle of coming out of hospital, attending the support group, then going back into hospital. The steering group, though supposed to be user-led, was controlled by the previous worker and a few powerful groups. Crucially, many of the SUN groups which worked with black and ethnic minority communities did not participate in it.

A new way of working with the SUN

Joe initiated a new approach to working with the SUN, consciously based on community development principles. He rejected a narrow mental health focus and instead aimed more generally “…..to shift groups and individuals towards a better level of health and wellbeing”.

Joe started with outreach work, visiting groups and individuals, which helped greatly to reinvigorate the steering group. Also he took account of what was culturally appropriate: for example never visiting meetings of a Bengali Women’s Group himself, but working through their coordinator.

Joe also changed the format of the steering group meetings so that half of each meeting was taken up with ‘training’ – focused on fun, getting to know each other, understanding differences and commonalities between people from different ethnicities. They did lots of work on power and people “really opened up”. Through these changes he encouraged new people to participate actively in the steering group.

A big event held after a year illustrated the success of this approach. 70 people came, and although there were still differences, the SUN was clearly now a genuine network. By autumn 2006, people you wouldn’t think would ever talk in public were co-chairing the meetings with Joe. By then people in the steering group really felt they had some power.

Social Services Funding – the Problems

Different definitions of success

From April 2005 Social Services, the funders, started applying a “managerial, mechanistic, one size fits all approach” to monitoring the work of the individual groups, based on tick boxes and focusing on avoiding overspending. They were inflexible and showed no understanding of the groups and their participants.

There were some very basic disagreements. For example Social Services criticised certain highly successful groups because they did not reach narrowly defined targets relating to what they termed “mental health principles’. They did not see the value of other kinds of developmental work – for example the work of one African Caribbean group in producing a booklet about the local history of slavery.

Inexperienced, inflexible and out of touch

There was generally a tense relationship with Social Services: the monitoring officer’s monthly visits to individual groups “felt like Big Brother”. Social Services also insisted on coming to Steering Group meetings, although these were meant to be a safe space for users to speak out. They used the meetings to introduce council consultations, which didn’t interest the Group members, and in any case were very difficult to understand.

Social Services’ approach to commissioning was very much top down. People were commissioning and running development projects with no development experience. They didn’t understand the difference between commissioning and directly managing; producing funding contracts so detailed that they specified hours, pay, targets – in one case even the job description. Their targets were inflexible and sometimes wildly inappropriate.

The Commissioning Manager “acted as if she were Joe’s line manager” in relation to the SUN project. She had no understanding of community development and saw SAfH’s role as the same as hers, concerned only with targets and funding. This led to clashes.

The Crunch

A new contract

There had always been talk of re-commissioning the SUN project, but SAfH thought there would be some consultation before this happened. Instead, in mid 2006 Social Services suddenly came up with a totally new contract, produced as part of a new user involvement strategy drawn up by a consultant.

To SAfH’s dismay, this gave primary emphasis to work on representing users to the statutory sector. The project would be mainly about persuading people to participate in user forums, with much less emphasis on development work. SAfH was emphatically against this, arguing that the two areas should be separated out. Otherwise the groups would mainly “feed the statutory sector machine” instead of working to their own agenda.

SAfH did want to continue with the development work, but not the other part. However, although Social Services recognised SAfH’s success and saw the need for continuity, they were not prepared to discuss any changes: they just wanted SAfH to put in a bid.

A tough decision for SAfH

SAfH were keen to continue working with the groups, and the contract would have guaranteed this for three years. But in the end they decided, reluctantly, that they had to refuse to tender. SAfH take a community development approach and didn’t want to work with people as ‘users’ or ‘clients’. The new user involvement model reflected in the contract completely contradicted their values as an independent organisation. If they took it on they would be firmly anchored to a statutory organisation with no understanding of community development.

The groups in the SUN were also unhappy. When the overall user involvement strategy had been presented to the steering group, they had found it impossible to understand and had not supported it. Although groups asked to see the SUN tender document and new contract in advance, this did not happen. They were outraged when the final tender and contract came out, and SAfH told them they would not be applying. Individual groups made representations to Social Services, but to no avail. To cap it all, the SUN was not allowed a representative on the interview panel – Social Services brought in a user representative from another borough instead.

Interestingly, once SAfH refused to tender, Social Services panicked and tried to persuade them to change their mind. They refused although Joe did stay on temporarily to ensure a smooth handover, for the sake of the SUN. An organisation from outside the borough got the contract – this in itself a reflection of the poor state of the voluntary sector in Tower Hamlets.

What are the consequences for SAfH and the SUN groups?

SAfH’s chances of future Social Services funding are obviously reduced but they are not unhappy about that. They were gradually winding down their Social Services contracts anyway, precisely because of the way the department operates as commissioner. SAfH are lucky – because of their diverse funding, refusing to bid in this way did not affect jobs.

But Joe and Elizabeth are concerned about what will happen to the SUN groups. If Joe could have carried on for, say, three more years, many would have progressed towards real independence from other host agencies – some were already achieving this. As it is, some are fragile and likely to lose their way.

SAfH will perhaps try and get funding to go on with some kind of work and they are in touch with some of the groups through other SAfH projects. Might there be an opportunity for groups to become social enterprises? SAfH’s long term dream would be to find a building for the groups where they would be genuinely independent.

The Lessons

Elizabeth and Joe identified some key lessons:

Community development and mental health

For SAfH, the experience has affirmed that a community development approach works in supporting people with mental health problems. The shift to this approach was very creative and dynamic for the groups in the SUN – importantly, it enabled the network to find out and work on ‘the people’s own agenda’. The work with SUN has provided a model which SAfH can build on in other projects.

Working for the community

The SUN experience confirmed for SAfH the importance of sticking to their own values and principles. Acceptance of the contract would have meant that

“Our freedom of movement and priorities would have been compromised….. whose tune are you singing to? We want to sing to the community’s not the funder’s.”

SAfH’s most important values can be summed up as “Start with the people”. Being value led has made a huge difference to their ability to achieve real transformation and change. But it means hey don’t necessarily know exactly what they will be doing when they start a project. Agendas emerge and are not set: for example, with a community research project, “we don’t know what we will find, leadership needs to come from the grass roots”. This goes completely against the current funding culture. But the point is to work with local people and what they want, otherwise you just become an extension of local government.

SAfH’s rootedness in the community brings the rewards that keep up morale and enable them to battle on. A recent example is a project on managing death in the Muslim community: SAfH was able to link up Muslims with Jewish groups which had similar religious requirements relating to death and had found ways to get official procedures adapted to meet them.

Funding and funders.

Since 2000, SAfH has made a commitment not to be funding led and has even given money back on occasion. But this is not straightforward or easy: this whole area is fraught with tensions and contradictions.

The SUN experience confirms the need to be firm from the beginning about insisting on a dialogue with funders – to have the confidence to question their approaches. It’s worth noting that not all funders take the same line: SAfH has been able to convince individuals within Hackney PCT that their approach is worthwhile and valid in mental health (this seems to be down to individual commissioners who understand, are prepared to listen and are flexible).

SAfH’s diversified funding base is crucial to their survival and they consciously aim for a mix of funders. To preserve independence, they previously made a decision not to go for core funding from the council, surviving instead on overhead management costs from individual projects. This makes their position quite precarious at times – for example they have had to issue redundancy notices – and necessitates a huge amount of fundraising work.

Commissioning must change

Statutory agencies often have the right intentions, but the wrong approaches: especially to commissioning from voluntary and community groups. Prescribing in so much detail what we should do and how we should do leads to dependence and ineffectiveness. This isn’t the way they commission from the private sector! Also the voluntary and community sector is increasingly being used to deliver services on the cheap. SAfH itself doesn’t sit in the service world: it could get money for this, but its independence would be compromised.

Current commissioning from the voluntary sector is resulting in ineffective services for excluded communities, and is stifling initiative and creativity. Instead, “ they need to let go and let us do what we can do well”.

Support for the voluntary sector

“This will kill off the voluntary sector”

This commissioning climate is creating a crisis in voluntary sector leadership.

The voluntary sector has allowed this to happen: no-one is speaking for our creative independence.

The sector is disempowered and afraid to speak out: “contracts have got a hold”. We desperately need an effective and disinterested second tier. Groups like CVSs are silent and ineffective: they “dance to the tune of the funders”. As it is, groups like SAfH have nowhere to take issues, no easy way of linking up with other groups.

Voluntary sector independence and democracy

Independence for the voluntary and community sector is a political issue.

It’s about constructive dissent and celebration of difference. To be truly independent and reflect local needs will inevitably involve an element of dissent, but everything is going the other way at the moment.

More broadly, central government is “scared of local democracy”. The poor political culture is demonstrated by the lack of participation in elections and party politics. “There is no oxygen at the base for political democracy”, and the politics of dissent is eroded.

The work of SAfH and others like them can help the most excluded to make a difference to the mainstream system. The voluntary sector can play a fundamental role in democratic renewal, but only if it retains its independence.