Sunday, 20 January 2013

Is the Suffolk Circle going to work?





"It starts from the premise that those who use a service must be involved in its design. The differences in status and authority between the professionals who run the service and those who use it have to be broken down."  So said Hilary Cottam, head of Participle (creator of Suffolk Circle) in The Guardian, 27 June 2010.

"The Axeman Cometh" said the Ipswich Evening Star on July 12 2010: "Which all means that the department facing the biggest shake-up at the county is adult and community services.... With an ageing population and the likelihood of more extremely old and frail people needing help in the years ahead, radical solutions are needed. That is why the county is pressing ahead with the “Suffolk Circle” aimed at co-ordinating local help rather than relying on council support.

This is being promoted even though the first such scheme, in Southwark in London, has attracted only a few hundred members. In future the county will be looking far more at families and friends to support those who need help before they fund social care." it went on to warn its readers.


What is the Suffolk Circle?

Suffolk Circle is a Community Interest Company which has been funded with £680,000 over three years by Suffolk County Council after a £100,00 'scoping exercise' to provide support to individuals very similar to Good Neighbour Schemes (GNS) but on a ‘token’ time-banking model.

This model charges the users for the support provided and employs a paid staff - the CEO of the schemes receive a salary of around £45,000 per year - but has promised preventive savings of £761,000 to Suffolk within the first three years and £2.1 million by the end of the fifth year. These savings projections were calculated by its parent company Participle. From the first circle in Southwark, others have also been established in Hammersmith and Fulham, Rochdale, Nottingham and more are in development.


SCC Scrutiny Committee minutes say that based on research undertaken locally; Participle projected that Suffolk Circle will be self sustainable by the end of its third year (February 2014) on the basis of a minimum target of 3,500 Circle members. 

Parent company Participle claims it can, "free of charge, develop this business case for you, upon your request. We will then meet with you, and your teams to help you understand how we could develop a Circle in your area, getting all stakeholders on side, and developing the necessary case for its investment. Typically a Circle costs around £200k per year for three years, before it breaks even, with no further revenue funding. Typically this investment will be justified through cost savings made in the first 3 years, with a 6 fold return on investment by the end of year 5, depending on local factors."

A County Council investment of £680,000, over three financial years, was agreed by SCC Cabinet on 25 May 2012 to support the development of the model. By the end of year three, it is planned to roll out across the whole of Suffolk.


Full disclosure: all views here are my own but I am employed to support GNS but I am sure several other organisations meeting the needs of older people like Age UK or WRVS or The Royal British Legion could also claim they could do the same with that money.

The news of such a large investment into an untried model upset the Bury St Edmunds Friendship Centre. Jane Andrews Smith, one of the organisers, told Mark Murphy on BBC Radio Suffolk on 9th March 2011 how they already provided the same benefits. 

One can see the attraction of the circle model for statutory bodies; they deal with one agency that won’t require, unless it fails, any further support, which is rather easier than spending the same money on a patchwork of 100-200 separate schemes in order to saturate Suffolk with a network of support. I am not affronted by the circle model but I do question whether a balanced view was taken on the ways to meet need because GNS, by their nature, do not have the capacity to brag about their accomplishments. The investment made by SCC in this model is ten times the cost of establishing over 30 Good Neighbour Schemes (which brought a host of wider outcomes) in Suffolk over the last ten years, where schemes are accessible to more than 60,000 people.

In the last few decades the Voluntary and Community Sector has had to adapt to operating in a competitive marketplace, each chasing a slice of private, public and statutory funding which is competitively tendered in a grant application process. This is very beneficial in that good ideas that actually work get funded and poor ideas or bad practise don't. At least, that's the theory.

A cynic might say, and there are many, that slick expensive presentations get funding over ones made at home and timing is everything. The first applicant that ticks the box when a statutory funder has a target or political imperative to meet (such as to outsource the public sector) will get funded.

I attended a presentation of the circle concept given at an annual LSP forum in November 2010 by Richard Hunt, head of Culture, Sport and Communities at Suffolk County Council, that implied by the slides (prepared by Participle) that good neighbour schemes in Suffolk along with 70 older people had been consulted as case studies in Participle's research though no GNS could subsequently recall that.

At that time I was very surprised that principals of Participle didn't make that presentation - the event is the flagship of local fora - but apologies were made. The Q&A afterwards was rather tense as Mr. Hunt naturally couldn't answer very particular questions those present put to him and promises to forward them to Participle wasn't satisfactory. The consensus from the conversations afterwards was that it was a done deal between Participle and the county and for anyone to make themselves unpopular with Suffolk County Council right then would not be politically wise, as there was widespread uncertainty about everyone's relationship with the county in their 'New Strategic Direction'.

Sir Roger Singleton has just reported to the Panel on the Independence of the Voluntary Sector where charities told the inquiry they felt increasingly unable to challenge policy or speak out because they feared losing contracts or influence. Many were self-censoring because they feared retribution from funders. The report concluded: "overall, we suspect there is an increasing unwillingness to speak truth to power".

I would like it on record that I have an open mind to the circle model, the GNS model cannot suit every situation but I have yet to receive an invitation to a round-table discussion on working with circles for local VCS organisations. The overtures I had mano y mano were akin to a cub reporter asking a bitter hack if they can borrow their address book.

Daily Telegraph 15 July 2011

The way that SCC foisted the scheme and the invisible principals of Participle undoubtedly undermined the goodwill of paid and unpaid community activists. Belinda Bell, Suffolk Circle's first CEO, alluded it was professional jealousy but said circles, unlike the detractors, are unique and not need-based. After looking up that charity-speak, I can confirm that Good Neighbour Schemes are not need-based either and I would vehemently disagree most rural people can get a lift to their doctor. If the focus of the business is not preventing more expensive social or medical care, what are SCC paying for? GNS schemes are more inclusive that a scheme aimed at the over 50.

Participle did a good job of selling themselves to the politicians but apparently not to people in networks who could endorse them. Perhaps they thought they don't matter, only the customer matters? Perhaps they were steered away by their handlers in case they got cold feet on sight of the baying mob. I don't offer conspiracy theories but in this vacuum, slick graphics and alternately erudite or cheerful copy written in London gives the impression this is an elitist corporate-political enterprise which is another case of 'we know what's good for you'. 

Participle would have won more friends if the principals had come to a few more village halls to convince people their motives come from their heart and not their wallet. Associates have noticed their absence at several community forums lately which Suffolk Circle were listed to attend. These forums are just as much for organisations to listen to each other as to users. It's a pity I haven't met Hilary Cottam. Having read a lot of her work I've come to imagine we're on the same page about a lot of things but I learned something from my dad who taught design; try building what you designed and using what you built before going to market. That she may say is precisely what is being done in Suffolk. Then there is a PR failure here. Circles have been positioned as a solution, not an experiment. Perhaps because the cabinet didn't have the guts to tell the electorate.

Personally I believe we do need innovative ideas in the way society achieves its purpose; that is to mutually meet our needs, and there is a huge legacy of failure and expectation which hampers new initiatives by requiring incremental progress carrying that baggage forward but when I have presented Suffolk Circle as one of a range of options at meetings in communities the reaction has been hostile. People are appalled that a business can make a charge for 'befriending' and it sometimes galvanises focus onto alternative models.

A danger for Participle and the circle idea is that its promise of delivery is used as a tool by a statutory body to divest itself of responsibility because of its political philosophy to demolish the public sector and not their pragmatic approach to redistribution of public resources. I wonder how the extraordinary way the decision was taken by SCC would fare against the Social Value Act (2012) now. If Participle expects users to buy tokens with state benefits and 'Direct Payments', why is that better than making it free to qualified users and the state funding it? Have you seen the nightmare bureaucracy it takes to deliver direct payments, which some say are just a make-work scheme for financial advisers to make a living administrating them for a cut?

Colin Noble, Portfolio Holder for Adult and Community Services on Suffolk County Council since June 2009 wrote on his blog: “in a nutshell, Suffolk has an ageing population and is getting less and less funding from Central Government to deal with it; but we are working on it, with Suffolk’s New Strategic Direction; with Suffolk Flexicare; with Suffolk Circle; with Suffolk’s care providers and the third sector and long-term with all of us here in Suffolk working towards the Bigger Society David Cameron is talking about nationally…”

This new paradigm pits organisations against each other to serve a particular 'need group', attract funding and take the credit for tackling society's problems. Naturally there can be sometimes double-counting of outcomes and in practise, sometimes the delivery doesn't quite match lofty ambitions.

Whilst competition is healthy and creates stimulus, to be healthy it must be overt, such as between football teams. However in the VCS it is often unspoken and can be insidious. Everyone has to put on a face of working in partnership for the public meantime stabbing each other in the back in the boardroom or quietly seething as a newly minted agency, flush with funds, steals the headlines - and so further funding - for something others do better but do not have the resources to crow about it. Competition and 'payment by results' can be a stimulus for bad practises too, consider the failures surrounding Atos or DWP contractors in the £5bn Work Programme. The various channels of statutory funding - by definition subject to political influence - is complicit in this by manipulating the funding streams to meet particular and ever-changing objectives.

To determine the winners and losers we need to keep score but Suffolk Circle's numbers are hard to come by and their metrics are hard to compare. It's as if one grocer sells carrots by weight, another by volume and no one knows the ratio of weight to volume. While numbers for GNS are scant of detail too, this because they are small groups of local volunteers more focussed on helping their neighbours than collecting data about them, and besides they are not responsible to SCC. But sifting through the press cuttings we can only extrapolate a few figures from Suffolk Circle and it troubles me that I cannot find positive references to circles in mainstream or community media and on blogs and forums not written by people connected to Participle.

Where is today's man on the Clapham Omnibus mentioning on a community forum this great scheme he's signed up with to look out for his Gran? I am pleased to read one story of a circle's impact on Stan, while I read many every year about GNS.

Suffolk Circle was launched on 14th February 2011. By 14th February 2012 it announced it had signed up 341 members, it been to around 150 social events and completed over 320 helper jobs.

I'd like to ask then, what does it mean by "been to"? I know it has attended events organised by the Rural Coffee Caravan and other bodies providing information events on a social model. I can't see that Suffolk Circle attending social events is actually delivering anything of value to members except awareness of their own scheme. Isn't this just advertising the scheme to attract members?

The 341 members it attained in the first 12 months is below the membership target Suffolk Circle published. However, the number of members is irrelevant as a metric of impact apart from the numbers of member represents revenue from its £30 joining fee, so we have a picture of its sustainability, whereas GNS cost nothing, there is no 'joining' of them. Gym clubs count on having more members who never go to the gym than those who actually use the gym. The metric that matters is how many members use the scheme. Suffolk Circle expects that each member will spend £99 per year on circle services including membership, or 5.75 hours per year. I would expect, based on GNS usage, there will be something like 90% of members who will not spend any tokens but renew a membership or have it bought for them. Membership attrition so far has been about 1.5%. It was said in the LSP presentation that a key market for the circles is the 'adult child' living at a distance who will buy tokens for their parent/s to use.

To be fair they had to start from zero and growth ought to be exponential as predicted as every member invites a friend or several others to become a member. Their membership targets are: Y1 404, Y2 1630, Y3 3500. To look at the potential of the Suffolk Circle, we could examine the data from the first scheme Participle established in the London borough of Southwark.

In September 2012 Participle said of the Southwark Circle in the Guardian:

"The social outcomes are measurable and the cost savings considerable. In Southwark, for example, we have facilitated 14,600 hours of social activity, reached more than 175,000 people, delivered more than 5,100 hours of support and established more than 170 local partnerships." Here it uses a completely different set of metrics by which it is being measured in Suffolk.

Southwark Circle was founded in May 2009, so counting up to September 2012 is 40 months.

I wonder what they mean by "facilitated"? Looking on their websites, the circles list lots of local events on their calendars and most it seems are not exclusive events, they are just existing events being advertised to their members, in some cases at an additional premium if booked through Suffolk Circle.

40 months is 1220 days, so near as dammit their facilitation is 12 hours of activity per day. What is the form of this facilitation, are they counting signposting people to activity as facilitation? Is this social activity something otherwise unobtainable and so wouldn't happen without them? Were circle the originators and hosts or did they just count the number of their members that attended existing provision? A GNS that hosts a monthly lunch club in a village hall where none exists (as some do) can rightly claim it provided those 2 hours of social activity per month and for the impact it could multiply that by the number of people that attended and the number of volunteers involved, as that is a benefit to them too.

If 20 circle members book a coach trip to see the Sound of Music (2.5 hours in theatre, 2 hours travel) do they claim that as facilitating 20 x 5.5 = 110 hours of social activity? Is it otherwise impossible for those members to have booked this trip with someone else? I would say it could only be fairly claimed as impact if there was no other provision, which in Southwark, in that scenario, is very unlikely.

Similarly I question "reached". What by; advertising? One poster on an escalator at Oxford Street will 'reach' 147,000 people a day.

5100 hours of support. That is 127.5 hours a month.

14,600 hours of activity is 365 hours a month.

Whatever the definition of activity and support, it is 492.5 hours a month in a borough with a population of 288,300 people (2011). For the moment let us set aside that circle schemes are only for older people whereas GNS make no age discrimination, since need doesn't either. The ONS estimates the percentage of population of "pensionable age" in Southwark is 11%, so let me be generous and put it at 30,000 people. If they've reached 175,000 people, isn't that 145,000 more than they needed to saturate their target population in Southwark?

Therefore the activity/support delivered in Southwark to their target population is .00165 hours per person, per month. I'd like to know their definition of 'support', as it alone is an ambiguous word constantly overused in VCS. It can be money, counselling, labour, facilities, signposting and many other actions.


Let me try some comparisons. The population of the market town of Halesworth in Suffolk is around 6000 people. With 19 volunteers, the independent Halesworth Volunteer Centre reported in 2011/12 it travelled 78,709 miles in a year taking people shopping and to hospitals, GP appointments etc., the same sort of support Suffolk Circle members can ask for. The town has a volunteer operated 'Hoppa' bus with conductors that assist vulnerable passengers so the HVC can be said to be serving more people with physical mobility or other issues rather than just meeting demand for transport because no public transport exists.

HVC don't record the number of hours volunteers spend driving and helping people with their shopping but if we assume they travel at a very generous 10 mph with stopping and shopping etc., that would be: annual hours = 7870.9 or monthly = 655.0 and instead of counting just the pensioners - undoubtedly they are the majority of who they serve - and we count the whole population; HVC delivers support at 0.1097 hours per person per month (about six and a half minutes).

If you're not good with zeros (like me) that is 16 compared to a hundred. HVC delivers 565% more support to everybody in Halesworth than the pensioners of Southwark get from their circle. That's just the Community Car Scheme but HVC also gives other personal support which I've not counted. So in terms of numbers, they've already lapped Southwark, climbed the podium and are drinking champagne at the post-race party. It's quite reasonable that HVC outperforms the two GNS examples; it has a paid staff, an office and telephone lines and volunteers are standing by on a regular schedule to respond to calls.

I have a few figures on Good Neighbour Schemes in Suffolk which put in the public domain at their AGMs and so on.



A fairly typical GNS is the parish of Aldringham cum Thorpe which has 700 residents. In 2011 they completed 262 tasks or 21 a month. In a larger village nearby the Wickham Market GNS in 2011 completed 836 tasks, or 70 per month for a population of 2400. Amongst the GNS schemes, this scheme is by far the leader in terms of quantity but the figures show it has parity with others in terms of efficiency in serving population.

"Task" though doesn't quite describe the extent of the work done. Some tasks are a simple visit or a trip to the shops (that is at least 2 hours of support) and across the schemes only 50% of the tasks are for transport but sometimes a call leads to hours of advocacy, which is willingly entered into but often frustrating and despairing as services, such as Patient Transport, are reduced in this time of austerity. Two hours of support from Suffolk Circle would cost you 4 of its tokens, between £20 - £24 depending how you bought them.

Let's be exceedingly generous to Suffolk Circle and say each task represents 1 hour of support.

location  
pop. served  hrs pcm  efficiency 

Southwark  
30,000 492.5  0.0164 

Halesworth  
6000  655  0.1092 
Aldringham  700  21  0.0300 
Wickham Market  2400  70  0.0292 

If you want that expressed as minutes per population each scheme delivers:

Southwark 56 seconds per person
Halesworth 6.5 minutes
Aldringham 1.8 minutes
Wickham Mkt 1.75 minutes

Whilst we have a huge number of variables and guesses in these figures, and we have not accounted for variation of need, but that isn't as much as people might think, we can plainly see how the GNS model outperforms the circle model in delivering support. The GNS here don't deliver as much as the volunteer centre but you have to consider the HVC and others like it are better funded and has a wider footprint that can encompass other GNS. Most GNS exist where there is no other support and when there is, they provide back-up and flexibility to frontline support.

But this is an exercise to demonstrate the difficulty of measuring claims of effectiveness, not damn somebody by those numbers. Voodoo number-crunching happens in every sector I've worked in; just ask Rio Tinto about its Mozambique coal. It seems everyone uses one metric for bids and another for reports and funders and county councillors just scratch their heads and figure it must be doing some good so vote it through.

Hilary Cottam wrote recently in Soundings 48: "Certainly we can see where we have introduced circles, our members’ visits to GPs have dropped off. They are no longer lonely, and are in better health, due to increased social activity - just one of the unpredicted benefits of this membership service for the over-50s."

Unpredicted eh? So that's not the purpose of the circle scheme and nobody told you that's what happens when you enable people?

At the time of writing this, Suffolk Circle has been going two years. From my conversations with them, I understand it has focussed its development on Bury St Edmunds and surrounding areas where it is based and where there are fewer competing GNS. I welcome this as there is certainly no lack of need in those places so it could be an ideal opportunity for them to show that a circle can be established where GNS haven't, though I haven't tried it with £680,000 to spend.




You may be surprised there is deprivation in Southwold

To be perfectly honest, I don't mind which model is used so long as it works at meeting needs but I do feel that the GNS model, with its inclusiveness and lower costs, run not by professionals but people's neighbours with the users and providers being interchangeable, is at a disadvantage because each is an organic localised scheme without a brand identity or a well heeled company who walk in corridors of power behind it. Incidentally, for the sake of brevity please read this blog for the evidence, the GNS model is not just for meeting social need but is also a platform for local community development. It many instances it has been the catalyst for realising new things or introduced people to volunteering. I would posit even that, to some, it might be a dangerous force, empowering the community and capable of advocacy and political influence. In the one-size fits all provision circles promise and councils want, somebody has to fight the GNS corner because it's foolish to put all the eggs of self-help and community support in one basket.

The greatest strength of the GNS model is the capability for variation and adaptability which, amongst the variety of agencies in the voluntary and community sector, will protect each scheme from obsolescence. In GNS schemes there is no difference between user and provider as they are all neighbours. If need changes, provision changes. Its limits are the resources available which limits circles exactly the same way.

The problem for Participle's model is that it is aims to grow too large and so too inflexible. 

A problem in introducing any new brokerage model is to 'capture' enough providers to meet need and enough need to stimulate provision; the 'critical mass'.

I recall a LETS scheme where I once lived which eventually collapsed because there were too many people offering head massages and watercolour classes and there were no takers for their tokens in exchange for plumbing or gardening.

For some time I have been voluntarily, in the course of everyday contact, encouraging tradespeople to sign-up to a 'Trusted Trader' scheme as this would be good resource GNS can refer their clients to. The reaction from every trader I have approached is "why should I bother, I have enough work" (there is a fee of £100 to register) and the view of some clients is there are names on the list they can't legally fault except they wouldn't recommend them to their friends. Each time I made the suggestion I put my credibility on the line as an endorser. Not surprisingly I've since stopped bothering.

The GNS volunteer doesn't charge the user; they see their gift as an investment in the social capital of their community. The challenge is to ensure the value of that currency. The customers/investors will accept its currency when they own the bank and the bank's model and I don't see where in the circle model the customers own it; they are "involved" in it, just as much as they are involved in deciding what SCC can do with their money.

Another issue I have with the circle model is that it says that the currency of GNS, social capital, is worthless, so people must trade with actual currency for which it takes a cut. Scale is a factor here. Social capital does not hold much value far from home. People don't expect it to be accepted abroad nor do they redeem from outside, at least not at 1:1. Like a bank, circles guarantee their currency will be redeemable forever, so long as they stay in business of course. Social capital is perishable but the way to refresh it is to spend it, keeping it in circulation: monet gratarium reciprocam retributionem (one good turn deserves another) is one of our oldest proverbs.

If a person is prepared to give their time to their neighbour for nothing, then if the means comes along that enables them to charge for it (so they can get back what they put in), then the market in social capital collapses and switches to money. With time-for-money we impose a much more rigid trading platform. Placing a common value of £6 per half hour on helper's time removes the flexibility to set prices and to some extent the commodities traded. If a neighbour's child needs collecting from a dance class next week, I wouldn't expect them to reciprocate as much as if they needed a lift now, but it's just as important that we can forgive those debts when the neighbour's need is greater than ours.

I have encountered scepticism in some communities that helping one's neighbour will be reciprocated, which the circle model overcomes but so does a GNS, but what's missing in the communities where I find that scepticism and the most valuable commodity to society, which only the GNS model builds, is trust. Even the richest, ablest country in the world has to proclaim that its last line of defence and the ultimate guarantor, written on every dollar bill, is their trust in a benign almighty: In God We Trust. Society only works because people trust that other people are inherently honest most of the time (and justice to transgressors will be fair), that work will be rewarded, that provision will be fair and trust that politicians and providers - our servants - act in our best interests. There is a way for both GNS and circles to co-exist but it must be deduced they have no faith in building 'trust' in communities.

I don't know the population of the places Suffolk Circle is established in now, it would be unfair to count the whole of Suffolk so let us apply the ratios used in Southwark to Bury and put their target population at 10% so 3500 people. With 320 tasks completed in year 1, its tasks were 26 per month so its efficiency was 0.0074 (26 seconds).

I hope in the following year the new CEO, who took over from the highly experienced 'social entrepreneur' who went to greener pastures after 12 months, has doubled their activity to catch up to Southwark. I notice that Suffolk Circle has since reduced its £30 sign-up fee with a coupon for six months free membership by a code advertised on its Facebook page. This must increase considerably the 3500 subscribers it originally needed to reach break-even then?


Circles lately seem to have dropped references to 'over 50' on their websites though it's there in the SCC briefing documents and older press cuttings. Participle lauds itself for its agile development process but if so, should the guinea pig pay for the costly experiments on it?

If we want to count impact, then I think the GNS has many other models beat hands down; the preventative impact of every GNS in Suffolk on reducing missed medical appointments (£120 each) falls prevention (£12,600 each) and supporting independent living (£36,000 per year) is in the order of hundreds of thousands of pounds. I find the impact on softer outcomes of keeping people connected, building social capital in communities, offering hope and the reassurance there is a safety net is incalculable, so I don't expect to hear Suffolk Circle making any claims for their effectiveness at that either.

If we were to consider that each GNS only costs a few hundred pounds per year (and they are not directly funded by SCC) only because of the requirement of public liability insurance and CRB checks, which the government could do more to reduce; we would see that the support GNS delivers would be tremendous value for money over the circle model for the county council if they were to fund GNS directly. And, being free to the user but with several controls against exploitation, GNS are incredible value for money to the entire population of Suffolk.

Please note that all I am saying here is there are some questions I would like answered. It would be interesting to have the data and the resources to make a like-for-like comparison across all the models of support being delivered in Suffolk. I suggest an independent body looks into that as soon as possible. I am sure Participle will hear of my queries and will respond in time.

P.S. After digging deep into the Suffolk County Council website (where you have to know the date of any meeting to find a document rather than the topic) it is reported that as of November 2012 Suffolk Circle membership is 1,115 and the membership trajectory is on target to meet the end of Y2 forecast of 1,630 members. On November 22 2012, Suffolk Circle tweeted they signed up 114 members on the Mildenhall Estate in one week. In December it announced by its Facebook page that it was offering free 6 month trial memberships for a limited period.

Again, I make the point it's not the number of members that matters but the kind of support given that really counts and let's hear what preventive value it has. As evidenced by its promise, Participle already has the social scientists and the IT infrastructure and the data on its members to provide the answers.

If my apologies are not apparent enough, let me say again I don't mean to be harsh but at the end of the day someone's going to decide if I should keep my job based on real numbers about real people.


ADDENDUM

On March 14th 2014 it was announced that Suffolk Circle would cease operations. By then it had only signed up 2000 members.

http://www.bbc.co.uk/news/uk-england-suffolk-26585520

Lib-Dem county councillor Caroline Page was particularly scathing in her condemnation of the waste of £680,000 of taxpayers money by the cabinet of Suffolk County Council, who had originally excluded the regular council from debating the subject.


In response to a story reporting the demise of the other flagship Southwark Circle a commentator on the Guardian website has grasped the issues; 

Suffolkperson
0
Your writer refers to the Circle scheme as a 'totemic project,' (why?) and seems eager to conflate provision of services, any services, for over-50s, with a long-term solution to the problem of care for the elderly. Perhaps your journalist should have considered getting out their calculator and seeing how long it would take for a fifty-year old to become a 'frail elderly.'
The other thing you have not mentioned at all, but which is very germane to the article, is the range of existing services being provided by existing local groups in advance of the various Circles being established. These were providing services to the same people as the Circle groups aimed to reach and have lost out to the tune of the however many hundred thousands that were pumped in to ‘prime’ each individual Circle project. Suffolk County Council spent £100,000 on an advance 'scoping exercise' which seemingly failed to identify the existence of any of these organisations. And yet they, rather than 'the recession' were likely to prove a stumbling block to Circle’s declared intention of becoming quickly self funding.

I am astonished at the gap between rhetoric and reality and the amount of sloppy thinking indulged in by everybody in this whole sorry saga. It seems to me that you, Hilary Cottam, and the various councils involved have a narrative of 'social enterprise' you wish to justify and therefore pay no attention to the facts.


Tuesday, 15 January 2013

Good Neighbour Schemes: filling gaps in transport services




Quite naturally voluntary and community organisations must account to funders their value and their return on investment. One aspect I find is that statutory funders tend to think of Good Neighbour Schemes (GNS) as a uniform product and so consider if statutory responsibilities can be fulfilled by facilitating GNS in a particular remit. Statutory funders would like to encourage GNS to assume responsibility for meeting some of their social care needs by offering the resources of funding and training and management support but want to account for that support with targets and budgets. GNS are keen for the support but are cautious about taking on responsibility for providing services on-demand. But in the way funders and sponsors provide support there is often the tacit suspicion that GNS serve people who could pay for their services, or because GNS do not have rigid controls on access; some must be taking unfair advantage. Also there is concern that GNS could duplicate services already being funded, thus provision must be steered in some way. GNS are often asked "how do you know there is a need for your service" but their answer "because people ask us" is not always satisfactory.

Every Good Neighbour Scheme (GNS) in Suffolk aims to support and complement the other community and social care services within the area it serves. A GNS is able to adapt and fit its resources around existing services because its organisational model is flexible and inherently in ‘standby’ mode without a costly overhead. Because of its ad-hoc nature and capability as a brokerage rather than offering a set menu of services, a call to a GNS is usually made when other provision is unable to meet a person’s need. GNS are a useful partner to many kinds of services and can be called up to take up any overload and then step down when normal demand returns. However, several GNS have reported that hospital social workers in Suffolk have sometimes discharged a 'bed blocker', unfairly imposing on the goodwill of GNS it should be said, and asked them to ensure their patient will be returning to a home with its heating on and a stocked larder and if someone could regularly call in on them to monitor their condition.

But those are extreme and isolated examples. Usually the first function of a GNS 'phone holder' when assistance is requested is to ascertain what other options have been already explored by the person in need. If by providing advocacy and advice the GNS can enable access to existing provision (for a lack of information is usually the case) this is usually a more efficient expenditure of the scarce and valuable resources of a volunteers’ time.

None of the Suffolk GNS in my experience were established with any advance views to only meet a particular need, e.g. to focus on befriending and not offer transport. The existence of established services is naturally considered and in nearly every case it is found that demand already exceeds supply and that the potential of the GNS to share the load and provide user choice and flexibility is welcomed by the existing provider. The impetus for people to establish a GNS is not that it is an amenity that would be “nice to have” but that there is an obvious, sometimes pressing, local need. It that need and the evidence that the GNS model can meet those needs within people’s capabilities which incentivises people to form and join local good neighbour schemes.

It would be hugely resource-intensive to map the variety of needs and resources available to the entire population with a GNS in Suffolk but the role of GNS in provision of transport to medical out-patient appointments at a local surgery or distant hospital can illustrate their value, as this task is the single greatest demand on them as a whole. Although from various factors it varies widely from scheme to scheme, it typically represents 50% of calls. 
Transport Types:

BUS - A public service running to a fixed route and schedule. Operated by both commercial operators and Community Transport Operators in rural areas in Suffolk. Some CTOs have paid drivers, some use volunteers. Bus passes are accepted.

CTO  - Community Transport Operator: either a charity, Community Interest Company or Industrial and Provident Society operating transport services on a non-profit basis with volunteer and paid staff. Some run regular buses on unprofitable but essential routes, some operate DRT and Community Car Schemes.

DRT - A demand responsive bus requiring advance booking and going anywhere in a limited area and designed to feed into towns from rural areas or to meet staged buses or trains. Does not normally operate within urban areas. In Suffolk they are run by several CTOs. Each has different call centres and opening times and different hours and days of service according to their contract with Suffolk County Council. Bus passes are accepted.

NEPTS - 
Non-Emergency Patient Transport Schemes operate like a DRT but only when the medical need is determined to a stringent criteria with a questionnaire when booking a journey. Services are round trip from the patients' door to the hospital or clinic with other calls on the way but free of charge. Run under contract to the Ambulance Service according to the NHS administrative structure so patients in Waveney District have a different service than the other districts in Suffolk. 

CCS - Community Car Scheme. A volunteer or paid driver with a car or minivan operating like a DRT and generally operated by larger charities, e.g. WRVS, or as a special service of a CTO with wider service footprint than GNS. 
'Wheels Within Wheels' are DRT using disabled accessible minivans, avoiding the need for volunteers drivers to have a PSV license. These scheme have specialist Public Liability Insurance with driver training and a staffed call centre contributing to overheads. They usually charge 35 pence per mile and receive subsidy from Suffolk County Council to reduce the passengers' cost. The drivers volunteer at regular times and are matched to passengers by the call centre on a first-come, first-served basis. 

GNS - The patient's neighbour using their own car and expecting reimbursement from the passenger at 45 pence per mile for journeys arranged between the driver and the passenger. Patients are matched to willing neighbours by the GNS phone-holder. Passengers are covered by the driver's car insurance under social use but insurers are increasingly reluctant to permit this. The schemes have Public Liability Insurance but it is very limited in order to be affordable, so the boundaries of their duty of care must constantly be asserted.

Hospital Rides - A Suffolk-wide online journey matching service which in practise is no different to a GNS although the patient and driver are not usually neighbours.
The primary option for a patient needing to travel to an out-patient appointment would be to attend by driving their their own car or be taken there by a friend or family member.

If they do not have a car or access to a car, their second option would likely be to get there on public transport with buses or trains and buses. Considering the cost of hospital parking - set to discourage car use rather than raise revenue it is supposed - people with access to frequent public transport would readily consider this option. Their concern would be whether its schedule was compatible with the appointment without undue waiting times and there is enough frequency if there was a delay or alteration to the scheduled appointment.

Large swathes of rural Suffolk do not have direct access to their hospitals and GP surgeries by staged bus routes, trains or combination thereof. Demand Responsive Transport is available in rural areas but this requires advance booking by telephoning an operator, sometimes in a very limited window, at least 24 hours in advance. Very often in practise a DRT journey to a distant hospital requires coordination between two separate DRT operators, with some juggling of both schedules by telephone. Therefore there is an exponential increase in failure points and feedback from users is that such multi-stage journeys can also involve waiting for a connection outside in unsheltered places.

If the patient is having a treatment that will make them unwell or incapacitated in some way (such as dilatory eye-drops) or is already unwell, then self-driving and solo public transport would be unlikely and unwise choices. They would therefore seek an accompanied mode of transport but two passengers would then double their cost. 

Besides a friend, a GNS volunteer with a car is the only other mode of transport that can provide the patient with an escort throughout the journey and allows for waiting time as an integral part of the service without increasing the cost of use. With CCS they usually cannot afford to provide a volunteer willing to wait for (or with) a patient for a long period so an out-patient journey may necessitate them charging the patient for two trips; there and back, with the CCS volunteer fulfilling another journey in-between.

The GNS volunteer driver is also the patients' neighbour and so is generally more willing and able to give the patient not only door to door service, but can offer support while waiting for treatment and when the patient returns home.

All the calls for medical transport that GNS have recorded have arisen whenever these transport options are not available. Transport requests when someone is capable of driving themselves are rare as the cost of GNS use would be higher than using their own car or bus fares. With the uncertainty of a volunteer being available against the reliability of the buses, calls to GNS by people who have the option of suitable public transport are also very infrequent.  

Without access to a car or public transport, the next option is a private taxi. A return trip from IP17 to the Ipswich Hospital with two hours waiting time is widely quoted at around £100, beyond the means of many, even those with an average salary or pension. Whilst there are some state benefits available to meet the cost of medical transport, several of the modes that rural populations are limited to using (such as taxis) are ineligible to be claimed, unless in exceptional circumstances. The role of GNS as advocates in claiming these benefits and providing transport planning can steer demand away from consumption of the scarcer resource of volunteer transport.

GNS are not a cheap taxi service, nor do they take away business from taxi firms although some have made this complaint to licensing bodies. When people cannot afford to travel, they do not travel. Suffolk GNS report that their transport service can actually stimulate local taxi use by keeping people active and sometimes a choice of modes enables a person to afford use of a taxi for one leg and GNS for another, according to the circumstances.

GNS ‘phone holders’ are adept at ascertaining the client’s need and generally, as they are neighbours too, they can signpost callers to the appropriate public transport options and can weigh if another mode of transport is more appropriate and are informed enough of local conditions to know if it is available.

Whilst being free of charge, NEPTS has stringent criteria of medical need for usage which have lately been tightened, or more uniformly enforced, which has lately shifted demand onto CTOs that operate minibuses and CCS with point to point service. CTOs report they have seen demand increase by 30% since September 2012. Due to their subsidy from local government, most CCS provide transport at a cost of 35 pence per mile but this is charged from the volunteer’s point of origin and return so is a variable on predicting the cost of journeys for the passenger. While run as non-profit organisations, CCS have a larger service footprint to GNS but also higher overheads, some with paid staff and offices.

GNS do not have any funding directly to subsidise transport costs (but having this would open up several issues with insurance and put greater demand on administrative resources) and so generally they ask the passenger to reimburse the volunteer at the HMRC permitted rate of 45 pence per mile (though this is below the true cost of motoring).

NEPTS users report that the service is sometimes late or too early (reliability is difficult to manage because of variables in collecting several passengers) while the journeys are shared with other patients and so are often of long duration “going around all the villages” and some patients have been stranded when a delay at their appointment has caused them to miss their ‘slot’ booked for the return journey. Also it is not usually possible to be accompanied on NEPTS by a friend or family member, though given that only patients with the most severe needs can qualify for it, the support of someone familiar to them is often necessary to that patient.

It is my experience that apart from staged buses and trains, the provision of rural transport information is very poor in Suffolk. Journey planning by DRT or community car schemes with web-based information is nearly impossible. The NaPTAN database and so Suffolk Traveline website cannot reflect DRT service times and every request directs the passenger to make telephone enquiries which are available in different areas at different times due to the variety of operators. The Suffolk On Board leaflet promoting CCS is confusing by lumping a wide variety of services in the CCS model together though each one offers very different services ranging from DRT, disabled accessible minivans and volunteers with their own cars. One CCS apparently offering volunteer drivers is actually delivering library books, not medical transport. Mapping the provision of medical transport at present would require considerable research. The changing menu of services can apply to the GNS too, which is why a county-wide GNS leaflet is not published.

This lack of information in turn frustrates the consideration of transport availability at the point when the appointment is set. GNS report that many hospital requests come for times that are outside the service times of public transport, though if the appointment was later, the journey would be possible by public transport. If a journey plan could be generated as every appointment was set and so times adjusted to suit, there might be much greater efficiency and improvement in numbers of missed appointments and delivery of medical treatment.

Between 2009 - 2012 there were 184,947 missed NHS appointments in Suffolk, costing£17.6 million. There is no hard data on the reasons why people miss appointments but local anecdotal evidence shows that poor transport, particularly in rural areas, is one reason. The West Suffolk Hospital says the cost of each 'DNA' to them varies according to whether it is a first or follow up appointment and for which speciality but the estimated loss is about £110 per appointment. That means a typical GNS can break-even in terms of public support by simply transporting three to five passengers per year who would have otherwise not shown up and based on 2008 figures, prevention of ambulance call-outs would have an even better return on investment as they cost in Suffolk £260 per call.

As voluntary organisations, CCS and CT operators are naturally subject to the vagaries of private and statutory funding of the Voluntary and Community Sector and the supply of volunteers and other resources. CTOs normally operate in places of ‘market failure’ where operation of a route on a commercial basis is not viable. In some instances, only non-profit operators have tendered for rural bus routes subsidised by the county council but pressure is still exerted in the tendering process to lower costs further by redesigning them after a few years as longer or different routes that CT operators are less willing to tender for, as recruiting volunteer drivers for longer shifts is difficult.

A recent case saw a long established and popular subsidised route that was taking volunteer drivers 4 hours to complete was withdrawn and re-tendered as an extended route requiring a driver for a 7 hour shift. A new bid from the original CT operator was rejected but their concerns that a consequence of the route re-design would be that the numbers of passengers boarding the service at the first stop would now fill the 13 seat minibus provided by Suffolk County Council, preventing other passengers from boarding the bus elsewhere on the route went unheeded but has proved to be the case. CT operators running staged services are finding in increasingly difficult to recruit volunteer drivers because of the licensing issues around derogation of the D1 license category and calls for action by Suffolk's CTOs on this have gone unheeded. In the short term this will force CTOs with volunteer drivers to be limited to offering smaller minivans under 3250 kg MAM which are financially unviable for staged or DRT service.

Some GNS find it difficult to recruit volunteers willing to give several hours of their time on long-distance distant hospital trips - such as Addenbrokes or Papworth from Suffolk Coastal - so will steer those callers to the local CCS who in turn sometimes have to refuse due to demand or limits on their service footprint. However these GNS are kept busy enough and can usually find volunteers willing to offer shorter trips to local GP surgeries and the ‘cottage’ hospitals, freeing the CCS for longer trips.

Whilst most forms of CCS and CT require a volunteer to commit their time according to a regular schedule, the GNS model asks the volunteer to be in a dormant or ‘standby’ mode. The volunteer is only called if needed and has permission to refuse the journey request. This GNS commitment is more palatable to many volunteers who would not join a CCS. Cooperation between a CCS and GNS can be very productive and be an efficient use of human resources and it can be a way for GNS volunteers to graduate onto more involved volunteering or greater responsibility, according to their choice.

The only disadvantage of the GNS and other voluntary help models for the statutory funder is their localism. Statutory bodies can't create more GNS by the stroke of a pen with investment of money and support services alone. It is generally but not entirely the case that GNS are active in areas where there are more affluent retired people because this socio-economic group are able to provide the mission-critical resource the GNS needs;  the able and active volunteer with a car. Those able people wish to support those less able and the needy of which there are enough in their area. The larger CCS schemes can redistribute their resources more widely this but make volunteering a less attractive offer and has far greater overhead cost.

There is considerable need for development of more volunteering for CCS or GNS patient transport but based on feedback from volunteers; issues with insurance, CRB checks and unmet costs are disincentives. It would be worthwhile for Whitehall to listen to the small plaintive voice of Good Neighbour Schemes and note their value.

Friday, 11 January 2013

The need for Good Neighbour Schemes


A definition of a Good Neighbour Scheme (GNS) is ordinary people doing everyday things for other people in their community when that is needed.

In Suffolk over 60,000 people in 39 communities have access to 30 good neighbour schemes which are supported by Suffolk ACRE.

There are also other voluntary help schemes in Suffolk but the Suffolk GNS is a unique model. In the UK there are other schemes called "Good Neighbours" but practically all other schemes generally serve a larger area and have criteria such as age, prior service, a medical condition, time limit or make a charge to access their services. Some employ paid staff and so have offices and overheads like a business while every Suffolk GNS is run entirely by volunteers from their kitchen table.


Good Neighbour Schemes build Social Capital, Networks, Community.
Access to a GNS in Suffolk is available to everyone living in the community that a scheme serves. There is no age or need criteria before you can ask if another neighbour can give you some help or perhaps just some company. It's not an emergency service but for most simple domestic tasks, a willing neighbour can be found.

Newfoundland, where my ancestors come from, has some of the harshest weather on earth. A proverb said there is: "look after your neighbours or you could die..." That aphorism recognises that the purpose of society is our mutual survival.

Every community has good-hearted people who will automatically help their neighbours, but the aim of the Good Neighbour Scheme is to fill any gaps in this network and to put help within reach of every resident of a community.

By the brokerage of a GNS, those in need of help have access to more neighbours willing to help and people are more willing to help their neighbours if there are other neighbours who will help too.

Abuse of people’s goodwill is quite rare and prevention is inherent in the system as all tasks depend on whether a neighbour is willing to voluntarily help another. A great number are. 

All the services a GNS provide apart from transport are free of charge. There are no joining fees, subscriptions or tokens to buy nor hours banked or exchanged by a LETS scheme. The user reimburses their neighbour for any expenses, such as parking or materials. For transport; the schemes ask users to reimburse the volunteer to cover their mileage at the HMRC rate of 45 pence per mile (this is well under the true cost of motoring today).

Current Schemes
District

Bildeston (Helping Hands)
Babergh
Brantham
Babergh
Harkstead & Lower Holbrook
Babergh
Long Melford
Babergh
Newton
Babergh
Shotley & Erwarton
Babergh
Tattingstone
Babergh
Lakenheath
Forest Heath
Bacton, Cotton & Wyverstone
Mid Suffolk
Dagworth, Old Newton & Gipping
Mid Suffolk
Earl Stonham
Mid Suffolk
Finningham
Mid Suffolk
Rickinghall & Botesdale
Mid Suffolk
Stowupland
Mid Suffolk
Stradbroke
Mid Suffolk
Wetherden
Mid Suffolk
Barrow & Denham
St Edmundsbury
Chevington
St Edmundsbury
Honington & Sapiston
St Edmundsbury
Horringer
St Edmundsbury
Aldeburgh AGNES
Suffolk Coastal
Aldringham cum Thorpe
Suffolk Coastal
Cookley & Walpole
Suffolk Coastal
Framlingham Our Help (Rotary based)
Suffolk Coastal
Kesgrave
Suffolk Coastal
Ufford
Suffolk Coastal
Wenhaston WeHelp
Suffolk Coastal
Wickham Market
Suffolk Coastal
Halesworth & Holton (Bus Buddies)
Waveney

Each GNS is different and each is devised according to the needs in the community and the willingness of those prepared to help others in their community. 

Every GNS is an independent organisation and is run by local volunteers. Each volunteer is a resident in the same community as their 'client'. Like a time-bank, neighbours can be both clients and volunteers in their local scheme and most are.

The schemes themselves determine what it is they can do and how they can help so there are differences between the schemes.

For example in Halesworth there is already a volunteer centre so the GNS model has been used to provide volunteer bus conductors on the 511 service to enable vulnerable and disabled people to use public transport and remain independent. This in turn reduces the pressure on the local community car scheme and supports the volunteer bus drivers and makes the buses a social space that reduces loneliness and encourages activity and engagement in the community.

In the villages of Cookley and Walpole the GNS will make housecalls but most of their effort is put into running a very popular monthly café in a community where there are very few facilities.

Many GNS are the ‘labour exchange’ for other community activity such as carnivals and fetes, emergency response, Neighbourhood Watch and sports clubs. All GNS work closely with other statutory and voluntary organisations providing help such as Safer Neighbourhood Teams, Age UK, WRVS and community transport schemes.

In Wickham Market, a new service grew out of their GNS where 15 of its volunteers took part in additional training to provide personal care to people to become the Wickham Market Family Carers Group.  This kind of community development is made possible with the platform of GNS schemes existing in the community.

The community development charity Suffolk ACRE (soon to become Community Action Suffolk) is able to help communities start a good neighbour scheme and then give ongoing support when any issues come up; this can be things like complex changes in the Government’s Vetting and Barring Scheme or car insurance rules which seem to change one year to the next.

Suffolk ACRE provides a scheme manual and community development officers to help a scheme get started which covers all the basics, based on their experience since the first scheme was started in Suffolk in 2002. 

Jane Cody, chairman of Kesgrave GNS said to the BBC: The most important thing I would stress is how much of a difference it made to be able to use Suffolk ACRE’s model and get their very wholehearted back up. They gave us all the time and resources we needed, their model is tried and tested, with the minimum amount of bureaucracy but adequate safeguards, and they add an instant gravitas and body of knowledge/experience which is vital when a well meaning group of locals want to energise and mobilise their neighbours into action!”

GNS volunteers have scheme identity cards and a Criminal Records Bureau check. Though the law does not require an enhanced CRB check of these kind of volunteers, except for very specific tasks involving medical transport and money, a CRB is a requirement for insurance.

GNS schemes are self-sufficient; the money needed for their public liability insurance, CRB checks and publicity and any other expenses is just a few hundred pounds per year and it is raised locally. Local people are willing to support their schemes as they see immediately what the money goes on.

The costs of supporting GNS are extremely good value for the service they provide. One missed medical appointment can cost the public purse hundreds of pounds. A house fire can cost millions. According to reports, loneliness and isolation is blamed for increasing demand on health and social care services, causing people to go to hospital more often and move into residential care at an earlier stage.

The task of establishment of these schemes (and its cost) would be even less if there was less demand for box-ticking paperwork. Volunteers are usually more interested in giving their time to helping people, not sweating over risk assessments or drafting an Equal Opportunities Policy or compiling statistics for grant applications of how many people they serve, their gender and orientation, and how many elderly people were prevented from falls, which is really quite impossible to quantify but plainly a GNS makes a difference. A point made in the Parable of the Blobs and Squares.


The highest demand on most GNS is for transport for medical appointments; trips to hospital and doctors at a pre-arranged time. This demand is because many people do not have friends or family able to take them. A trip to hospital for an outpatient appointment by a taxi with 2 hours waiting time will be in excess of £100 from IP17 postcode to the Norfolk & Norwich.* A GNS volunteer or community car journey would be around £40 for the same. A neighbour would also be more able and flexible to wait with the user and see them safely home again. *Quotations obtained October 2012.

Many communities with an active GNS are isolated from public transport and what alternatives there are, such as DRT, are very often incompatible with appointment times and with travelling to hospital when you are unwell.

According to the Department for Transport; 21.1 % of people in rural Suffolk live more than 60 minutes by public transport from hospital compared to 9.9% of rural England overall. Source: OCSI 2011 Department for Transport (DfT) 2009.

There are 35 LSOAs (each averages a population of 5000 people) in Suffolk more than two hours travel time from a hospital by public transport.

Another peak demand is transport for shopping or a volunteer to do shopping when someone is unwell or has come back from hospital. Schemes sometimes provide, depending on volunteers, more intensive support for person back from hospital or with a long term illness until social services arrangements can be made by committing to a certain frequency of visits for a limited time.

There have been instances (thankfully few) of people being discharged from hospital without any support at home when someone has called a GNS to say that the patient is being discharged that day and could the GNS go to visit them. The GNS volunteers are put in a position where they cannot refuse and it puts them into conflict with statutory organisations they prefer to work in partnership with. 

Those few instances have been addressed but such demands from statutory services put GNS in a defensive position of stating what they cannot do more than what they can offer. GNS have always had to draw a line a lifting, dressing or feeding someone or complex needs. There is always more demand for such care than they can supply and the many issues of insurance and competence and duty of care are beyond their resources.

There is a ticking time-bomb of dementia in the ageing UK population and so increasing demand for local support of the patients and their carers. Local solutions similar to the GNS model such as the Debenham Project can go a long way to meeting that need. Meantime in-patient beds in the Waveney and Yarmouth area are being cut from 42 to 20 and the number of acute dementia beds from 12 to 3, with 500 front line NHS posts being reduced across Norfolk and Suffolk.


All GNS are excellent at signposting as they are local people with local knowledge on what works and what doesn't, when the shops are open, which shops deliver, what's on at the village hall tomorrow and who are the local tradesmen, the sort of information a distant call centre can't possibly keep up to date.

Some GNS volunteers have experience from their working lives or have enough willing to advise or advocate on behalf of a vulnerable or disabled neighbour and their families to ensure fair and proper access to services. For many people completing a 14 page form and obtaining photographs (requiring a journey) is a considerable barrier to obtaining a bus pass.

A high proportion of people when surveyed ask nascent GNS for befriending and a greater number have the need but are reluctant to ask. All GNS offer volunteers who can check in regularly with neighbours to give them social contact and GNS provide somebody they can call if they need some help with a small domestic problem. It might be changing a light bulb, which is vital to prevent falls, or resetting a boiler or thermostat or just checking in on behalf of distant family and giving reassurance to those living alone, maintaining their independence. Some GNS hold keys and emergency contact information for relatives of people living alone or people who are both working and caring for someone.

A fairly typical GNS is the parish of Aldringham Cum Thorpe which has 700 residents. In 2011 they completed 262 tasks:

Shopping or social transport                                                                     33
Medical transport                                                                                  149
Garden tidy, DIY etc.                                                                              64
Sitting with or checking on a vulnerable person                                            10
Pet sitting or walking                                                                                6

In a larger village; the Wickham Market GNS in 2011 completed 836 tasks, or 70 per month for a population of 2400. 

"Task" though doesn't quite describe the extent of the work done. Some tasks are a simple visit or a trip to the shops (that is at least 2 hours of someone's time) but sometimes a call leads to hours of advocacy, which is willingly entered into but often frustrating and despairing as services, such as Patient Transport, are reduced in this time of austerity.

The latest scheme is in Kesgrave and is the most ambitious to date as it has a population of 15,000. What was surprising in the initial survey was how many people there wanted social contact and the large number of people willing to help.

Wickham Market GNS has recently stepped up efforts to recruit people interested in befriending on a regular basis because of the number of people who say they are isolated or are vulnerable. 

Some of their clients already receive care arranged by social services but a half-hour carer visit doesn't achieve much; “there isn't much socialising in getting someone up and dressed” says its chairman John Hoe.

Wickham Market GNS also involves young people through the Duke of Edinburgh Scheme. The young volunteers do gardening, leaflet delivery and dog walking. Their parents are involved and briefed. There are not a lot of other opportunities for young people to volunteer in Wickham Market. The GNS also organised a Jubilee garden party for over 50 of their users.

Other impacts of GNS are that volunteers can support local charities by arranging collection and transport of donated furniture and clothes and collecting and returning electric blankets for the Fire Service. Wickham Market’s volunteers have done village litter picking, maintain the churchyard and maintain the Resource Centre’s gardens. These kinds of tasks are done by the other schemes too.

In the last few decades the Voluntary and Community Sector has had to adapt to operating in a competitive marketplace, each chasing a slice of private, public and statutory funding which is competitively tendered in a grant application process (let's set aside the process of moving into sustainability). This is very beneficial in that good ideas that actually work get funded and poor ideas or bad practise don't. At least, that's the theory.

A cynic might say, and there are many, that slick expensive presentations get funding over ones made at home and timing is everything. The first applicant that ticks the box when a statutory funder has a target or imperative to meet (such as outsource the public sector) will get funded, even if they ask for £800,000 to set up in three years something that has already existed for ten years that runs on 5% of that. They just didn't know that funder had money burning a hole in its pocket.

These days there is increasing desire amongst statutory funders to make every agency meeting society's needs (and in a sense its failures) sustainable, i.e. self funded, with the users paying for the service. However, it is quite obvious when you are tackling deprivation, that the lack of such means is the issue. There are many burdens it is simply the duty of a civilised society to shoulder as a whole: thus should national defence be made sustainable? Ah, but we all benefit from defence, so everyone should pay for that, say the sustainability advocates. And...? says the community activist.

This paradigm pits organisations against each other to serve a particular 'need group', attract funding and take the credit for tackling society's problems. Naturally there can be sometimes double-counting of outcomes and in practise, sometimes the delivery doesn't quite match lofty ambitions. The funders employ experts to scrutinise the applicants and so the funded organisations have a considerable overhead in accounting for themselves.  

Whilst competition is healthy and creates stimulus, to be healthy it must be overt, such as between football teams. However in the VCS it is often unspoken and can be insidious. Everyone has to put on a face of working in partnership for the public meantime stabbing each other in the back in the boardroom or quietly seething as a newly minted agency, flush with funds, steals the headlines - and so further funding - for something others do better but cannot crow about. Competition and 'payment by results' can be a stimulus for bad practises too, consider the failures surrounding Atos. The various channels of statutory funding - by definition subject to political influence - is complicit in this by manipulating the funding streams to meet particular and ever-changing objectives.

Good Neighbour Schemes are frequently invited by statutory and voluntary bodies to develop further services and take part in local consultations. The NHS want to find ways to prevent people going into hospitals and more support from such schemes can obviously be part of the solution but it is not the solution alone.  Providing more support to people with social care needs in the GNS model is not really about money, it’s more about providing the means and removing the barriers and discouragement to volunteers willing and able to help.

To find out more about Good Neighbour Schemes, visit the Suffolk ACRE website.