Four golden threads — what the voluntary sector brings to treatment and recovery

Since August last year I’ve visited many charities around the country hard at work supporting local (and in a few cases not so local) people struggling with their drug or alcohol use, and, in some cases, their nearest and dearest too.

I’ve been to Brighton in the sun and Leeds in the rain. I’ve witnessed lives in the process of profound change in the town centre of Rotherham and the beautiful countryside of Wiltshire. I’ve chatted with parents in a therapeutic community in Sheffield whilst they cradled their babies, and said the serenity prayer with people in York in the final sessions of a six week ‘day-hab’. In HMP Pentonville I saw how drug treatment is integrated into the everyday life of prison, and how hard negotiating that system can sometimes be. In Exeter I spoke all afternoon to the workers who support the men in the local prison, many of whom have been in there multiple times. In Bristol I heard how the shared-care system locks drug treatment tightly into primary care, sustaining vital care pathways. In Harlow I saw how visible recovery in a residential setting can inspire the people detoxing alongside them. In Hertfordshire I heard how the roasting and brewing of coffee can be just as important a part of recovery as key-working or a medical intervention.

With Cranstoun staff — and Caroline Lucas MP — at Pavillions in Brighton

None of this means I have a definitive understanding of exactly what’s happening in every area in England — no person or organisation can boast of that — but it does mean I’ve got a good feel for what these organisations are doing, and can do, for people struggling with some pretty serious life challenges. As you might expect very few people seeking this support were struggling with just their drug and alcohol use. This multiplicity of challenge means that practitioners — as well as being skilled in key working and psycho-social or pharmacological interventions — must be able to navigate the many parallel and interlocking systems that govern our lives. One day knowledge of universal credit it needed to unblock a seemingly frozen benefit payment. The next the focus shifts to getting to know a new worker at the local mental health service to establish a pathway and ease a referral. It’s all in a day’s work.

The impacts of the political shift to localism and the revisions of the Health and Social Care Act of 2012 has left us with a jigsaw of provision with the actors and power-brokers of each areas working in harness to shape an effective response to local need. It’s worth saying of course that the voluntary sector can’t do this on its own. In many areas there is deep partnership with NHS providers particularly around the clinical aspects of opioid substitute therapy, and with other community organisations such as domestic violence services or food-banks.

Having made these trips and reflected on the wisdom of the experts I spoke to — including of course those with a lived expertise in addiction and recovery —  I began to think about the essential characteristics of the voluntary sector in this context. What places us to make a unique contribution to the issue of drug and alcohol use? This distillation process has left me with these four observations.

With Michael and Rosie at Clouds House
  1. We are driven by values and want to change the world. Many charities were created in response to serious political, health or social injustices. In addition to delivering services to some of the most vulnerable people in our society, many of Collective Voice’s members are vocal at the local or national level on issues they consider morally pressing.
  2. Charities arise from the communities they serve — whether defined by geography or shared human experience. This gives them a ‘by us, for us’ feel and makes them natural partners for community level social action and recovery services including mutual aid or peer support structures. It also means charities can gain access to communities, and work with populations of people, for whom more obvious agents of the state would be denied access. This is a very useful attribute when we’re talking about historically highly stigmatised groups of people.
  3. We have space to innovate. Our organisational and cultural DNA — as well as our legal status — means we can experiment and take risks in the way we approach things. This thirst for innovation has proved vital, whether contributing to life-saving harm reduction measures in the 1980s or harnessing the power of digital to widen access to brief interventions for alcohol users in 2019.
  4. We thrive through partnership. Many voluntary sector providers in the world of substance use (and more widely) have started small, and prospered through successful partnership working. Not being big enough to do everything yourself means collaboration is essential, which (ideally) then encourages the delivery of joined-up services to citizens with joined-up problems.
Meeting at Forward Leeds with NHS and commissioning partners

I believe these four golden threads run through the living tapestry of not just our story as a nation but many of our stories as citizens, family members and human beings. However, being only ten months into my role here at Collective Voice I’m aware there is lots more to discover, in terms of both the varied systems that exist to enable recovery, and the voluntary sector’s unique perspective at the heart of some of those systems. I look forward to writing a sequel to this post next year to consider if these four points need revision, and if a fifth needs to be added. Do leave a comment below if you’d like to make suggestions.

4 Responses to Four golden threads — what the voluntary sector brings to treatment and recovery

  1. Jen L 21/06/2019 at 12:19 am #

    Hi Oliver, have seen you speak a couple of times in your new role. You are a fantastic advocate for small services in the drug and alcohol field and I’m impressed with your efforts to visit services and get to know staff and clients. Thanks for your hard work.

    • Oliver Standing 21/06/2019 at 1:09 pm #

      Hi Jen,

      Thanks for that, I’m pleased to hear it!
      I have another couple of trips planned and look forward to visiting more smaller charities.

      All the best
      Oliver

  2. Sara McGrail 05/07/2019 at 1:04 pm #

    Interesting blog but I think you’re missing some salient points about the changes there have been in the “Voluntary” sector. The organisations you represent sit right at the top of the sector – in terms of scale, finance and power. They do not in many cases reflect the experience of smaller agencies. In fact its arguable that they are in and of themselves problematic bodies in terms of delivering on what you describe as “golden threads”.

    Many charities are values based. They do deliver services that meet the needs of their beneficiaries in ways which are innovative. However the growth of the “super charity” – organisations that have incomes in the tens of millions – have a different impact on the market and on delivery. Large charities have complex and multilayered infrastructure to support their work. That infrastructure will continually grow to support the organisation. But to maintain that infrastructure the organisation must continually grow market share. When growing market share becomes the key measure of success, innovation, values base (except insofar as it is a marketing tool) and local connections, often go out of the window.
    Small and medium sized charities have suffered the most under austerity and this has been aggravated by the need/desire of the larger charities to continually increase market share.

    We have seen many small and medium sized charities lose their contracts to the larger players over the past ten years. And with the loss of those charities the field has been diminished. Its is small charities that grow out of their communities and remain close to them. Small charities are nimble and able to innovate. To change the approach of a larger charity is akin to turning an oil tanker. It takes time and money to do so. When I look at the business practices of many of the larger providers in this sector in the UK,I don’t see innovation – though I am aware of at least one large charity making an attempt to “turn the liner round ” in terms of personalisation. What I see largely are large scale organisations imposing their specified model of delivery on communities in which they have no base, no record of working. And that model flattens innovation.

    For many smaller charities engaging in partnership with larger charities often feels more like a takeover by the back door. The trend towards commissioning consortia means that the contracts for smaller providers are often not with commissioners, but held by the larger charities themselves. Effectively the smaller charity becomes a subcontractor to the larger one – effectively undertaking “piecework”. When this happens a very important critical voice is lost.

    This is not a phenomena that is limited to the drug and alcohol sector – its impacting right across the wider health and social care sector. The level playing field small organisations were promised in the heady days of 2010 has not materialised.

    So I admire your optimism, but wonder at your ability to sustain it.Perhaps Collective Voice is planning to do some genuinely innovative work to try and redress the balance in the sector. Perhaps you are at this moment exploring a code of conduct for the multimillion pound industries you represent that will protect smaller organisations? It wouldn’t take much of a commitment on their part. They could agree NOT to bid for contracts where commissioners exclude small providers on the basis of unfair turnover thresholds? They could establish much fairer approaches to contract management for any small charities with whom they subcontract, enabling a sustained relationship for those organisations with commissioners and beneficiaries. They could establish a fighting fund to enable small threatened organisations to survive in the communities in which they have grown? They could – again for subcontractors – ensure they are paid fairly for what they do – not simply offering piecework rates, but a real rate that covers 100% of costs including infrastructure costs. They could also stop taking on contracts as “loss leaders” that enable them to use their substantial reserves to weather the hard times while waiting for local competitors to go broke.

    • Oliver Standing 09/07/2019 at 11:09 am #

      Hi Sara

      Thanks for your comment. To pick up a few of your points and provide a bit of information which I hope is helpful.

      Collective Voice’s development has been supported by its members but our focus is on the wider policy and structural issues which impact on all providers and people getting help. I’ve aimed to begin to build a systemic understanding of our sector through a series of visits to project and providers, big and small, voluntary sector and NHS.

      We have been doing lots of consolidation work over the past year or so and are now preparing to go ‘on the road’ with some events in the Autumn. These will be a series of ‘system snapshots’ in local authorities which will of course each have their own set of challenges and local terrains. The events will also highlight the good things that are happening around innovative projects, partnerships etc. They will have a strong focus on smaller voluntary sector providers and feature the voice of lived experience. We will also be inviting the key local actors such is the Directors of Public Health and commissioners. We believe in a post NTA and DrugScope world there is a usefulness in simply bringing people together to talk and listen.

      These events will be the springboard for ongoing conversations with groups in the sector as we move into the next phase of our work. 

      We will also be launching our new strategy later this year which make it clear what our longer term goals are, as well as how we will share good practice within the sector (such as the Drug Related Death guidance we did with the NHS Substance Misuse Providers Alliance and supported by PHE https://www.collectivevoice.org.uk/news/joint-work-collective-voice-nhs-phe-improve-clinical-responses-drug-related-deaths/).

      With best wishes
      Oliver

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