Closing hospitals should be our goal

I watched the Chancellors’ debate with interest last night. All three missed opportunities for killer blows – I guess everyone was nervous.

My favourite question was from an A&E doctor who asked which of the three could guarantee the maintenance of front-line services in his department. Cue lots of assurances from both the Tories and Labour about protecting the NHS at all costs.

However they all missed the opportunity to provide a much more progressive answer to that question. That is: of course we want to protect front-line hospital services for those who need them, but the real opportunity in health care reform must be to keep as many people out of acute care as possible and seek opportunities through a greater use of the third sector to further improve primary and community care. Services should be re-designed and re-prioritised so that fewer and fewer people end up in A&E, resulting in better more tailored services particularly for those with long term conditions, allowing people to stay in their homes, and delivering savings to the stretched public purse.

Consider the opportunities. Someone with diabetes can quite easily end up in A&E if they have not been able to administer their own medication. However support from a third sector organisation at a modest cost could prevent that admission and save the huge costs associated, as well as avoid the suffering for that individual.

Our recent manifesto published with sector partners showed the example of Age Concern South Staffordshire who run a support service for elderly people who have been discharged from hospital, supporting them in those first few vulnerable days. An investment of £0.5 million has saved over 8,000 hospital bed days at a cost of almost £2.5 million.

There are countless other examples but this debate is something of a taboo with the general public and particular with the press. The “reconfiguring” or closing on acute services is always met with great resistance from local campaigners, even when the money saved will be used on better primary care or where those hospitals have been deemed unsafe.

As third sector leaders it is time for us to lead on this debate. We must be bold and advocate for a better balance between acute and primary and community care, with a significantly bigger role for the third sector. This can dramatically improve outcomes for patients, but is can also save huge amounts of public money at the time when those savings are most needed.

This means some hospitals closing. We should celebrate this as a success for the third sector and those we exist to support. After all, no one actually wants to be in a hospital if they don't have to be. We have the potential to harness the voices of our service users to help lead the debate about how we reform health services. Image the power of thousands of diabetes suffers hailing the closure of a hospital because they are receiving better primary care. It would certainly be harder to resist than NHS managers talking about efficiencies.

This potential for reform is why our victory over Burnham’s disastrous preferred provider policy is so important. The third sector has so much to bring and we must be allowed the opportunity to do so. Rest assured there are other significant vested interests who will continue to fight against such reform but it’s time for the sector to champion this change. Service users know what they want and third sector leaders are ideally placed to help to convey that message.

Can Business Save The World?

This week I am finally back in the office after the nastiest bout of flu I have had in years.

One advantage of having all that time was it allowed me to catch up on my reading. I have just finished Michael Edwards new book Small Change, Why Business Won’t Save the World. Edwards has had a prestigious career in the sector and was for many years a director of the Ford Foundation in New York.

As in his previous works, Edwards’ argument focuses on deconstructing what he calls “Philanthrocapitalism”, the trend in the non profit sector towards market forces and business discipline being harnessed to expediate greater social change. Grouping together a slightly amorphous group including social entrepreneurs, venture philanthropists, and social investors he picks apart the philanthrocapitalist ideology for its lack of evidence, its arrogance and crucially that it may undermine the more traditional non profit role of stimulating social change.

Edwards does not believe that more effective use of the market can be a means to solve many complex social problems because often it is the market which has caused those problems. Real social change can only come about from the grass roots advocacy role within civil society stimulated by a desire for social justice rather than income generation.

Citing Albert Cho, an academic who studies this field worldwide, he draws the distinction between “ the social entrepreneur asking, ‘how can I mobilize recourses to solve this issue,’ rather than, ‘why does this issue exist?’” Edwards challenges us: “Do we want to address the symptoms of social inequity, or do we want genuine social transformation?”

This is a fascinating challenge to our sector where the wind is most definitely in the sales of the social entrepreneurs and investors. I think Edwards is right to highlight the limitations of philanthrocapitalism, and the fact that the distinction between social enterprise and the more traditional non profit sector is often over stated, particularly by social entrepreneurs themselves. (I wrote a blog on this topic a few weeks ago.) As Edwards reports public charities in the states already receive over 70% of their income from the sale of goods or services. The danger for social enterprise is that as presenting itself as the panacea it can only disappoint. An interesting sub-text for Edwards is the fact that new philanthrocapitalists are often better at presenting themselves and explaining the changes they are trying to bring about than parts of the traditional sector, perhaps because of a corporate training in communications. But that doesn’t necessarily mean that they are better at bringing about real social change or have any firmer evidence for those changes.

For me though this challenge is slightly overstated. It would of course be a tragedy if what Edwards calls citizen philanthropy was lost at the expense of purely market based solutions to tacking social justice; but that isn’t really on the cards. Instead the two can and should exist side by side. Both have faults and both have merits. Some social problems can be tackled by using the market, others can’t. It is incumbent on us in the sector to try to fully understand the causes of those problems so we can develop the right solutions. As Edwards himself highlights “Its not that our old ideas about social transformation were perfect; it’s that our new ideas are imperfect, too, and almost certainly won’t turn out as planned”.

Also in the book there is a particularly good analysis of the difficulties of comparing different organisations and the perils of trying to develop simple tools to measure comparative performance, and a healthy challenge to both philanthrocapitalists and the foundation community to improve accountability. I’d recommend it to anyone interested in where the sector is headed.