Archives for the month of: September, 2013

by Kamal Mashjari of the Al-Ghazali Centre in Liverpool

Policing has always been and will always be a hot topic for all sections of society. Policing plays an important role in the fabric of our lives that is hard to avoid. However, in many places in our country police forces have remained unchanged for decades with little or no accommodation to the changing reality of the communities they serve.

In Merseyside our police force has remained much the same it has been for decades. The recent census told us that the BME population is now up to 10% in certain areas such as Liverpool but Merseyside Police has a BME workforce of just over 3%. Some will say ‘so what’, sometimes that is the way things are and with time this will change. However the bigger picture tells a different story. A police force that is unrepresentative of the communities it polices is less understanding of those communities. With a lack of understanding come huge problems – where police and community mistrust each other, over a period of time this builds up a level of resentment that acts like a torch paper. It then doesn’t take much for small incidents to get out of hand on both sides.

The recent riots of the summer of 2011 in Liverpool clearly shows this level of resentment against the police. Many of the rioters did not care about social issues effecting their communities or even about stealing property and goods, they just wanted a fight with the police. Those involved were not just BME but white working class as well. Many travelled by taxi from areas like Croxteth and Norris Green to join in the battle. These two communities, BME and white working classes, are the two that have the most issues with policing and feel the police are not representative of them or their communities. They feel very strongly that Merseyside Police does not understand them and that due to this lack of understanding, police are over-zealous in how they deal with those communities.

Among the most contentious issues faced by both BME and white working class communities is the issue of stop and search. It isn’t simply an issue of being stopped but the manner in which police stop members of the community and the reasons they are stopped. Some officers have no idea how to deal with the people they are stopping which causes enormous resentment from those stopped. Why do many police officers act in such an unfriendly manner when dealing with some of our communities? I believe the reason is a lack of understanding of some of the communities they police. Police officers do not work with many BME people in the police force and their only engagement is usually when dealing with crime or stop and search.

How do you change the perception of police when dealing with BME communities? You do it by employing more BME police officers to help police those communities. You make your police force more representative from top to bottom and not just in a token way. Only when large numbers of police officers are engaging with BME officers and communities will they have a better understanding of those communities than they do now.

All of the blame cannot be left with Merseyside Police but also with our own communities. Why aren’t BME people applying to join the police when recruitment is open? During the first PCC elections in November 2012, the turnout was poor everywhere in the country especially from BME communities. Imagine if the BME communities had engaged with the candidates on a large enough scale to raise the issues effecting them and then went out to vote in large enough numbers, they would have decided who won on that historic night. Instead the BME communities stayed at home disinterested.

It is now more important than ever that BME communities engage with the police services across the country, especially in those areas like Merseyside where there are large disparities in the numbers of BME police officers to community size. We must organise ourselves and open channels of communication with those police forces affected to insist that they introduce policies to encourage BME people to join the police when opportunities arise and they must ensure that they are able to retain those BME officers after they join. When BME numbers are sufficient we will likely see much less mistrust of police by BME communities and police of BME communities. Also, we need young people to join the police cadets program and also for a significant increase in numbers joining the police as Special Constables and PCSOs as this is likely to be one of the few routes into policing for our communities in the future.

To help raise this very important issue, we are organising a conference called Equality in Policing. I hope you are able to join us – https://www.eventbrite.com/event/8136595777. Now is the time to act.

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By Richard Caulfield, Chief Executive, Voluntary Sector North West

On Monday last week, I attended a day looking at the potential opportunity for voluntary & community sector engagement with commissioning support organised by PCC, Macmillan, NHS England, Neurological Commissioning Support and ACEVO in London. It was a well attended and well facilitated day – but it asked more questions than it answered for me!

The overriding difficulty for me was that we all had slightly different views of what commissioning support is. This is not surprising as in many respects it is a relatively new concept – in other respects it is what many organisations have been doing for years but have never called it that.

I assumed that the focus was based upon the compact between ACEVO & NHS CSU Network, and the opportunity to explore the potential for building commercial opportunities between CSUs and voluntary sector organisations. This also built on my previous experience of exploring this agenda for VSNW and Regional Voices which led to the research ‘Towards Effective Commissioning’, when we tried to look at the concept of commissioning support at the start of the health reforms. Then, as now, we struggled to keep the conversation away from the role of VCS as a service deliverer.

I don’t think we really managed to answer the exam question on Monday despite some excellent debate – and some nuggets of good practice – and when it came to what could happen next, there was some difficulty in identifying practical activities.

Let me list some of the key issues that sprung to my mind during the discussions and the thinking behind them:

1)  There appear to be a continuum of VCS engagement in commissioning support
At one extreme, the VCS as a general supporter of the process. In Manchester there was a recent call for evidence for the JSNA to help develop some of the work streams. This is commissioning support, as is taking part in surveys and consultation exercises that may help commissioners make better decisions. Many in the sector will give time freely (capacity permitting) to do this as this may be what their cause is focused on. A big question then might become – if an area is redesigning their Stroke pathway for example, how involved should an organisation like the Stroke Association be for no charge and should it develop a paid offer alongside or instead?

In the middle is the VCS as a paid provider of a commissioning support service. For example, a CSU or CCG may approach someone like the Lesbian and Gay Foundation to help look at the needs of the lesbian and gay community during the redesign of sexual health services. They may pay for expert staff time, data analysis and even community engagement to ensure the services that are developed have maximum reach. This is where Neurological Commissioning Support and Turning Point appear to operate.  (Interestingly, on the dedicated commissioning support website, Turning Point are considered Independent Sector not Voluntary).

Indeed, much of the investment in CVSs and other voluntary sector infrastructure is essentially commissioning support as this involves supporting commissioners in navigating the sector, promoting new ways of delivery and co-ordinating and supporting the engagement of particularly smaller and local groups engagement in providing evidence to influence commissioning – from high level priority setting to service redesign.

At the other extreme, the VCS pay to be involved. This may not appear logical but it does show how powerful commissioning support can be when we get to service redesign. It has happened for some time with a number of big nationals, such as Macmillan, contributing significant amounts of money to help service redesign in areas such as Manchester and Staffordshire. It is by no means a new model and others have done similar things. They believe by helping the service redesign, they are directly improving the service that will be received by the patient group they focus on.

2) What is and what isn’t commissioning support?
We discussed an awful lot about patient and public engagement. In my view, this is a subset of commissioning support and the VCS can provide access to some of the communities that commissioners sometime struggle to engage with. Community engagement may be part of the offer but one would expect CCGs or CSUs to do a lot of this on a day to day basis and have strategies in place. However there may be room for an offer that is based on specific moments in service redesign that takes that engagement a step further and support a very targeted engagement.

So if a VCS group wants to sell commissioning support, it needs to be really clear on what the offer is and develop a package.  I think it has to be more than an offer to provide general community engagement and needs to be sophisticated in terms of data collation and analysis and more. It is unlikely that a community engagement offer in one geographic area is going to generate the sort of income necessary but nationals like Turning Point, as highlighted earlier, have developed a model at scale which they can sell to a range of commissioning bodies.

3) Data as an asset versus open data
Now if you have access to a load of data from delivering services, research or other means, do you lob that into the mix of discussion – or do you turn it into an asset you can sell?  This can create a moral dilemma as the collaborator, as the influencer in you may want to share and use the data to influence. However the ‘business manager’ in you may feel the need to generate income from it – after all, the sector is constantly being told to be more business-like.

4) Capacity of VCS, CCGs and CSUs
My current experience is that there is less and less space for thinking and working partnerships through as we all have real pressures on time and budgets. I don’t think a ‘saleable’ commissioning support offer is financially practical for most small local groups: local infrastructure may be able to help devise an offer but even then I think this is optimistic and may be best done as an extension of existing arrangements.

Certainly many CCGs will have little capacity to spend any more on commissioning support as many have little breathing room within the centrally dictated financial envelope. This means the best chance for the sector will either be CSUs or possibly Clinical Networks.

5) Market Immaturity
Part of the difficulty with 4) is that the market is still immature. CCGs are only just working out what they want from CSUs, now they have a few months under their belt. Also, CSUs are working out how viable their current service offers are and we are all trying to learn how we interface with Clinical Networks. There is going to be more turbulence in the system and people and organisations will disappear.  This in itself makes it difficult for the sector to develop the relationships necessary  to take the leap into developing products with and for partners.

6) Geography as a barrier
Getting a ‘local’ offer together will be difficult and require work by infrastructure organisations to produce something worthwhile if the smaller local groups are to engage in a big way. Unfortunately there are few infrastructure organisations who operate at the geography of CSUs or Clinical Networks. This not only means that services will be slow in developing but it also means that there will be a range of ‘navigators’ of the system that the NHS bodies will need to engage with to understand the sector.

7) Provider v influencer
There will be cries of ‘conflict of interest’ if those who support commissioning see the aim as creating services that they are ideally placed to provide. This can be a fair criticism but can also be overcome with transparent processes from all sides.  There is a challenge though as sometimes the conclusion of VCS engagement in the process may be to move services out of the sector. VCS involvement in commissioning support is NOT and should NOT be about increasing VCS role in provision of services – it must be about ensuring best services for patients and service users.

8) Grant provider
One of the key roles the sector can play – which is a commissioning support role – is both encouraging the use of grant programmes and either facilitating them or supporting the delivery of them. There are examples across the North West of the sector doing this in recent months – Macc in Manchester will be supporting the delivery of a grant programme for the three CCGs. As I said at the outset, there are some things we already do that is commissioning support – we just don’t badge it as such.

To go back to the start, whilst some of the sectors activity is commissioning support, I don’t think this is just about rebadging. There is an arena for exploring the potential business opportunity for some of the sector – and space to re-emphasise the importance of good engagement. Ultimately, ‘going for it’ with commissioning support requires great commitment: of time, money and resources. Neurological Commissioning Support has developed over a number of years and required (as I understand it) significant central NHS funding and investment of the partners own funds to help develop an effective model. Partners will need ongoing reassurance that this way of investing is the best way of improving services if investment is to continue.

I suspect, in the immediate future at least, commissioning support services (paid for) will generally be for the big condition specific organisations who have the scale and resource to take the risk and perhaps a few brave equality groups who can make the case/take the gamble – Turning Point perhaps being the exception. Operating effectively these larger organisations may engage with smaller local groups in their networks but commissioning support as I define it, providing a sellable service to the CSUs, CCGs, Clinical Networks and others will remain a minority sport for many in the sector.

By Kirit Patel, Race Equality Programme Co-ordinator, Oxfam UK Poverty Programme

How you would feel if your next meal depended on a foodbank voucher, or if you couldn’t afford the heating bill, or faced the real possibility of losing your home? For many Britons, the prospect of ‘getting on’ is being gradually replaced by ‘getting by’ and ‘making ends meet’. These are not just ‘ifs’ and ‘maybes’ but daily reminders of living on a precarious and marginal income, and this harsh reality is affecting more and more people across our inner cities, rural areas and coastal towns. The impact is particularly felt in England’s northern regions which are historically and economically more disadvantaged than their southern neighbours.

However, what is even more disturbing is the outrage that our national politicians and media show to people ‘living off the state’. A quick glance at relatively recent headlines (“strivers v shirkers: the language of the welfare debate” , “jobless face benefit cut unless they learn English”), the current welfare reforms and the public support for reduction on welfare spending shows the hardening of attitudes towards people in receipt of state support. A large proportion of this public anger has been reserved for, and directed towards, the so-called ‘work-shy’ or ‘scroungers’ portrayed as hooked on a culture of free entitlements, daytime TV, booze and cigarettes, and on the vast amounts of public money wasted through fraud (the actual figure is less than 1% of the total welfare budget).

The truth for most receiving state assistance is the daily grind of surviving on a low income in any one of our run down estates, in jobless deserts with few opportunities to escape poverty and the constant struggle to ‘make ends meet’.

Prevailing attitudes vs reality
Why are people unwilling to hear the basic facts on poverty? Why is challenging negative attitudes on poverty such an uphill battle? Why has the demonisation of people living in poverty by our media and political classes become so acceptable? It is difficult to have answers for all of the above. For many people, the poverty they experience is because of low pay, caring responsibilities, their gender or their race, or because of where they live. Many people find themselves in the flexible labour market where increasing numbers have zero hour contracts with no guarantee of an income, or simply working long hours without a living wage. Many who are struggling on these low or unreliable incomes have to top up their wages through in-work benefits on a long term basis. Today these people increasingly have to deal with government means tested assessments of their needs – too often bureaucratic, complex and inflexible systems where delays and mistakes are common.

Those welcoming the recent wave of changes to the welfare system and incentives aimed at ‘making work pay’ have more or less disregarded the harmful impact of these changes on the very people they are supposed to help. The strict regime of sanctions and conditionality, cuts to public services and reduced frontline support will further push many more claimants into crisis and make it more difficult for them to move into the security offered by paid work. Despite this, the poverty debate is not centred on how the welfare budget is better protected for the poorest in our society or those in crisis. Instead it is concentrated on who should be entitled to it and, primarily, whose entitlement we can take away and how much we can cut the welfare payments of those who still remain.

The consensus that once existed that the welfare state is ‘a good thing’ – moral and just – is replaced by its harshest critics on the rising cost of supporting it. The elephant in the room is that the focus remains on the cost of the long term unemployed when in fact nearly half of all welfare goes to pensioners. The welfare state has become an easy target for our policy makers, as it struggles to meet ever-increasing demands with inadequate resources fueled by the UK’s economic woes and the push for greater austerity measures.

What can we draw from the current welfare debate?
At the heart of this debate are more fundamental and challenging set of questions before us: What is the welfare state for? Is it about providing short-term aid to those in poverty or is it about preventing poverty? Some would argue that the welfare state is about recognising and tackling the causes of poverty through redistribution of the country’s wealth so as to create a more equal society. Why are we so tough on those least able to fight back? Yet over the last decade, we have let off lightly banks that caused the financial crisis, or large corporations who continue to dodge tax on a grand scale. People reliant on the state do not need our sympathy or our pity and it is important we hear their voices and experiences in decisions that affect their lives.

One of the central pillars of the welfare state is to offer a minimal level of subsistence to all those who need it. In short, the aim is to provide a safety net and reduce the worst forms of hardship: state protection from the cradle to the grave. We all know someone or will one day be someone who needs some level of state support; whether you are a pensioner, unemployed, disabled, homeless, or affected by ill-health; or if you work in a poorly paid job, or part time because you have to look after children or other family members. So it is in all of our interests to ensure that it works, and the welfare state is fit for purpose.

The universal rights-based principles of free access, equality, and care and support for all are now under threat, as we have moved towards a culture of individualism, self-interest and free market ideals. Wider notions of responsibilities, the euphemistic ‘fairness’, targets, efficiencies, profit, and outcomes seem now to have a greater say over the running of our state institutions and structures…for better or worse. Surely we can offer a positive, alternative narrative for the many millions who are struggling from day to day, and trapped in a system of our own making that is being controlled – and decimated – by those who will likely never need to use it. In these uncertain times, we have to ask ourselves: What kind of society do we want? And, importantly, are we prepared to invest in it in order to achieve it?

 

By Richard Caulfield, Chief Executive, Voluntary Sector North West

I have a habit of bringing out old blogs as they become relevant again and now it is time to revisit my Redistribution of Health blog from July 2012.

At that time I was bemoaning the desire of government to implement the Advisory Council of Resource Allocation (ACRA) formula on public health funding to the settlements that local authorities would receive. The fear of that formula has not come true in public health as yet but in a dangerous twist, discussions about implementing the formula are now taking place with Clinical Commissioning Groups (CCGs).

The formula was initially developed (I believe) to address what the government perceived as anomalies in how health funding was distributed and a need to move to a ‘demand’ led approach to health care planning. This means essentially moving money to areas with ageing populations and away from those areas with greatest poverty (that may be a crude interpretation!).

Have a look at this table and see if you read what I read. Liverpool is perceived as having £50m too much spent by the CCG and Sefton £30m – the total ‘over target’ for Merseyside is £111m. When it comes to Manchester, the city itself looks like a big loser with over £40m over target which is outweighed by ‘under target’ areas across Greater Manchester. Lancashire is strange as Blackburn appears to be a big winner whilst the outlook for East Lancs seems terrible.

A quick glance at the figures for the North West overall looks like we are something over £140m above target – about the same as Thames Valley is under target. It seems the North alarmingly is £722m overfunded and any implementation of these funding targets could be disastrous, not just for health services and tackling health inequality but for the entire Northern economy.

There is no suggestion that the government are about to implement these changes in full but they might and if they do the timescale it is done over is crucially important. They also might use this formula to justify not giving increases to areas where they are seen as over funded as resources become available.

Education is going through a process of ‘ironing out’ what is considered spending anomalies and the government has stated the maximum cut that any school could receive in one year. It may be that the government is happy to do that, but the impact across the North West and the North as a whole could be huge.

The difference this year though is that the decision to move to a new formula and the pace of move to it is now an operational one belonging to NHS England. I cannot for the life of me believe that it will help NHS England in its aims of tackling health inequalities. The review terms of reference makes reference to the equality duties and one hopes it includes an Equality Impact Assessment on any changes being made. This has to be top of the list of questions.

I am aware that some in the health system are already briefing MPs and I heard a chief executive of a major provider describe these as the most pernicious attack on NHS services ever. The voluntary and community sector would undoubtedly see cuts in those areas where funding would need to be reduced to meet the formula, putting even more services at risk than at present. In the North West, we need to be joining forces with allies within the health system and local government to ensure these changes are not implemented.

It is worth raising this issue at our Health & Wellbeing Boards and voicing your concern with your CCG to see what they have to say at present and seeing if you can make joint representation. Voluntary Sector North West (VSNW) will raise awareness and concern where we can. This might include Local Enterprise Partnerships as I can’t see that taking such huge sums out of areas like Merseyside will help them deliver the growth in the economy they need!

Should there be any move to implement the formula, VSNW would expect:

  • A full Equality Impact Assessment to be undertaken
  • Reassessment of the formula by increasing the weighting based on poverty
  • A minimum funding guarantee – as they did with schools – which will guarantee that no CCG will receive a ‘cut’ of greater than 1% in real terms in any year: this feels like a least worse option right now!

The fact that some of the region may benefit significantly from these potential changes cannot mask the dangers this poses for our most vulnerable communities and we must not allow this thinking to go unchallenged. Surely a government committed to fairness and a NHS committed to tackling health inequalities can see that – can’t they?