Kate Baxter reviews research showing how the third sector can innovate in disability services in order to deliver care in times of cuts and restraint
Many voluntary sector projects demonstrate key gains such as increased independence and well-being
Key words: Voluntary organisations ❙ disability
Author: Institute of Public Care, Oxford Brookes University, on behalf of the Voluntary Organisations Disability Group (VODG).
Title: Gain without Pain – How the voluntary sector can help deliver the social care agenda for people with disabilities, Institute of Public Care, Oxford Brookes University (September 2010).
Aim: To describe how the voluntary sector can offer innovative ways of meeting three challenges facing social care: increasing demand; decreasing funds; and changing expectations.
Methodology: Ten case studies of voluntary organisations, each one showing a different way of offering innovative delivery of services.
Conclusion: The voluntary sector has much to offer to make the challenges to social care less painful and the gains greater. Commissioners and providers have a shared role to play in listening to the needs and priorities of service users, and in jointly translating these into a choice of services that delivers the outcomes people want.
Disabled people have been hit by a double whammy in the past year, according to a report by the Voluntary Organisations Disability Group (VODG). First came the squeeze on benefits announced by the chancellor in his first Budget; now the services on which many depend are bracing themselves for a major reduction in government expenditure.
The study begins by outlining the challenges for social care “when the prospects for public spending are bleak”. It goes on to raise concerns about temptations in the public sector to achieve short term-financial targets by providing the same services but on a smaller scale and more cheaply, while doing little to address longer-term issues.
Ten charities that are members of the VODG – the umbrella group for voluntary sector providers of services for disabled people – took part as case studies, and are used to show that there are alternative ways to meet the current challenges. Based on this evidence, the report finds that the voluntary sector is well placed to help the public sector achieve efficiencies.
The first of three sections in the report is entitled “Pain” and describes the current challenges facing social care: the demographic challenge of increasing demand as the number of older and disabled people grows; the financial challenge of meeting social care expenditure, especially in the current financial climate; and the challenge of changing expectations.
The latter includes issues such as the balance of relationships between purchasers, providers and users of care; tackling duplication of services; and focusing on prevention and the role of communities.
The second section, “Gain”, outlines the growing importance of the voluntary sector as a provider of core public services, particularly in health and social care. The report notes that many voluntary organisations have graduated from receiving small grants for existing projects to being commissioned to deliver core services.
It claims that a selling point of the voluntary sector is the “quality of its paid staff and the added value of its volunteers”. Using one-page summaries of the 10 projects undertaken by VODG organisations, the report shows what the voluntary sector can achieve.
Each summary gives bullet points of the key gains, a brief description of the project and an overview of the benefits. The projects are often, but not always, small scale with key gains such as increased independence and well-being, health or social care savings, service user involvement and prevention of longer-term costs.
The final section is “Gain without pain”. While careful to avoid postulating that everything the voluntary sector does is positive, it begins by highlighting three benefits that the authors believe the voluntary sector provides. These are: added value, through co-production and voluntary contributions; quick and flexible responses and person-centred deployment of staff; and enthusiasm and expertise from entrepreneurial managers, dedication to a single issue and, commonly, reciprocity and mutualism where those who volunteer are also those who receive help.
The remainder of this section concentrates on ways in which the potential of the voluntary sector could be realised. The main points appear to be a desire for voluntary organisations to have opportunities to engage with joint strategic needs assessments, cost-benefit analyses to identify the added value that voluntary organisations provide and careful consideration of the interplay between the demise of long term contracts, market development and personalisation.
The main purpose of the latter is to try to ensure that, at a time when the promotion of personal budgets may result in fewer or smaller local authority contracts, small-scale providers are able to continue to provide services and invest in the future, thus enhancing choice. With shared working, effective market intelligence and freedom to innovate, gain can be achieved without pain.
The report aims to promote the benefits of commissioning the voluntary sector to provide health and social care services. As such, it is not impartial, but offers instead a broad ranging overview of what the voluntary sector can offer.
Commissioners might find the case studies useful sources of information when considering forms of delivery and alternative outcomes. Voluntary as well as other independent sector providers might also find them useful illustrations of ways to present summaries of the costs and benefits of their services.
It is not clear from the report what form of analysis lies behind the case study results and how robust these are, although presumably this information can be obtained from VODG (readers are asked to email firstname.lastname@example.org for more information).
One method that may have been used is social return on investment (SROI), a new and developing method of analysing the costs and benefits of organisations aiming to deliver social or environmental as well as financial returns. SROI analysis is usually used by voluntary organisations or social enterprises to map their impacts as well as provide a ratio showing the financial value of returns on investment.
This form of analysis is being promoted by the Scottish government and what was the Office of the Third Sector. It is also being used by some local authorities (see the LARIA conference presentation in Further Reading). Although comparisons of SROI ratios across organisations are not valid, this form of analysis is becoming a respected method of showing the range and magnitude of costs and benefits that are important to stakeholders.
● Voluntary organisations provide a range of services and are keen to help local authorities use resources effectively. Early dialogue and involvement in the process of local area needs assessments and planning may be advantageous.
● Commissioners play key roles in reducing expenditure and in developing local provider markets. Innovative service delivery models may help to maintain choice within markets while also contributing to efficiency savings.
For support planners and brokers:
● Support planners and brokers have a key role in providing information to personal budget holders about the range of support options available, including those provided by voluntary organisations.
● Providing information to commissioners about personal budget holders’ choices (including desired but unavailable choices) is an essential part of developing the market.
For voluntary organisations:
● Robust and independent evaluations of the costs and benefits of services, with care taken not to overemphasise the impacts, are important in illustrating the value added by voluntary organisations.
About the author: Kate Baxter is a research fellow at the Social Policy Research Unit, University of York
● Kim Elliott and Rob Morris (2011), Social Return on Investment with Voluntary and Community Sector Organisations. Presentation given at LARIA conference 2011.
● Irene Hardill and Peter Dwyer (2011), “Delivering public services in the mixed economy of welfare: perspectives from the voluntary and community sector in rural England”, Journal of Social Policy, vol 40, no 1, pp157-172.
● Jim Phillip (2011), “Measuring and evaluating the social benefits of patient health education”, Health Service Journal, 7 March.
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This article is published in the 27 October 2011 edition of Community Care under the headline “Role of boluntary groups in disability service provision”