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Voluntary sector annual survey Findings from the Health and Care Voluntary Sector Strategic Partnership 2015 survey

April 2016

NAVCA Voluntary sector annual survey 2015 2

Voluntary sector annual survey

Introduction The Health and Care Voluntary Sector Strategic Partnership1 has a terrific reach into the many thousands of local charities and voluntary organisations in England. It is estimated that through the Strategic Partners, over 500,000 organisations across the voluntary sector can be reached.

This is the second annual survey carried out by the Strategic Partners following last year’s inaugural survey. It ran from October 2015 to January 2016. It uses the reach of the partnership to find out more about the experiences charities and voluntary organisations have of local and national health services. Understanding these experiences is taking on a greater importance because of the growing policy emphasis in health on increasing voluntary sector involvement and person centred care (for example seen in the adoption of the six principles for engaging people and communities2 in the NHS Planning Guidance).

1 For more information about the partnership visit http://www.voluntarysectorhealthcare.org.uk/ 2 The Six Principles for engaging people and communities, National Voices http://www.nationalvoices.org.uk/sites/default/files/public/news/download/member_briefing_2016_-_six_principles.pdf

NAVCA Voluntary sector annual survey 2015 3

Section A: Who took part? Overall the survey received 610 responses from charities (after duplicates and responses from non-voluntary sector organisations were taken out). Not all respondents completed all questions and as to be expected the final questions received a lower response rate than the earlier questions.

This response rate makes this the largest known survey of the voluntary sector that was conducted in 2015. Other notable surveys of 2015 included the FSI Small Charity Index3 that has approximately 300 responses and Local Giving’s Local Charity & Community Group Sustainability Report4 based on 538 responses.

1. Income of respondents We asked respondents about their income. This was to get an idea of the size of organisations answering. It allows us to see if there were any differences in responses according to an organisation’s annual income and to understand how representative the survey’s respondents were compared with charities as a whole.

3 http://www.thefsi.org/policyresearch/scindex/ 4 https://localgiving.org/what-we-do/reports/sustainability-report

Less than £10,000

16%

£10,000 -£50,000

10%

£50,001 -£100,000

9%

£100,001 -£500,000

29%

£500,001 - £1 million10%

£1 million- £10 million16%

Over £10 million

5%

Don't know6%

What is the annual income of your organisation?

NAVCA Voluntary sector annual survey 2015 4

To provide an idea of how representative this survey is we are able to compare the income of respondents to this survey with figures from the NCVO UK Civil Society Almanac 20155. By making this comparison we can see that respondents to this survey from medium and large charities are over-represented and smaller charities are under-represented. This is the pattern that you would expect from this type of survey. Smaller charities are often volunteer run and so getting them to take part in survey’s can be difficult. That said more than a fifth of respondents were from charities with an income under £10,000 and a third had income under £50,000. No other survey has been as successful in getting responses from organisations of this size and it demonstrates that the Health and Care Voluntary Sector Strategic Partnership reaches out to the smallest voluntary organisations across England.

5 NCVO UK Civil Society Almanac 2015, http://data.ncvo.org.uk/

Less than£10,000

£10,000 -£100,000

£100,001 -£1 million

£1 million-£10 million

Over £10million

survey responses 14.5% 19.3% 39.1% 16.2% 4.9%NCVO almanac 49.3% 33.8% 13.7% 2.8% 0.4%

0%

10%

20%

30%

40%

50%

60%

perc

enta

ge

What is the annual income of your organisation?

NAVCA Voluntary sector annual survey 2015 5

2. Geography of respondents Respondents were asked to say where their organisation was based. The results show respondents to this survey correspond closely with the overall regional distribution of charities according to the NCVO UK Civil Society Almanac. This means gives confidence that the results reflect the national picture. Typically charity surveys, for example the two mentioned in the introduction, have a bias towards responses from London and the South East.

7% 8%

20%

7%

12%

15%

13%

7%

11%13%

8%

18%

3%

10%

19%

13%

9% 8%

East ofEngland

EastMidlands

London NorthEast

NorthWest

SouthEast

SouthWest

WestMidlands

Yorkshire

Respondents by Geography

Respondents to this survey Distribution of Charities according to the NCVO Almanac

NAVCA Voluntary sector annual survey 2015 6

3. Size of area covered We asked “What size of area is served by your organisation”. Two thirds of responses were from organisations covering less than a region and 43 per cent covered a single local authority area or smaller. This again demonstrates the ability of the partnership conducting this survey to connect with the smaller charities, voluntary organisations and community groups that many other organisations, particularly statutory ones, can find hard to reach.

0% 5% 10% 15% 20% 25% 30% 35%

Single neighbourhood, locality or parish

CCG area

Local authority area

More than one local authority area

Region

All England

All UK

EU / Europe

International

Don't know

What size of area is served by your organisation?

NAVCA Voluntary sector annual survey 2015 7

4. Who do they work with? We wanted to know about the people who the respondents worked with. For this question respondents were invited to tick all that apply. The results show that the respondents deliver services to a wide range of people, reflecting the work of the whole voluntary sector.

What groups of people does your organisation work with? (Please tick as many as apply.)

All/the general public 43% Women 41% Men 39% Older people 41% Children and young people 41% Adults 46% Families/parents 39% Carers 39% Employers 16% People with physical disabilities and / or special needs 44% People with long-term conditions 41% People with learning difficulties 38% People with mental health needs 43% People from Black and Minority Ethnic communities 33% People with a particular financial need (including poverty) 25% Asylum seekers / refugees 13% Homeless people 16% People with addiction problems (e.g. alcohol, drugs) 22% Faith communities 16% Lesbian, gay, bisexual people 19% Transgender people 16% Socially excluded / vulnerable people 40% Victims of crime and their families 11% Offenders, ex-offenders and their families 18% Unemployed people 28% People experiencing domestic abuse 17% Other charities, social enterprises and/or voluntary organisations 50%

NAVCA Voluntary sector annual survey 2015 8

5. Main beneficiaries As well as asking about all the people that groups work with we wanted to know about who the main beneficiaries were. This was to help us with the analysis and to help us to make comparisons between groups working with different people and different communities. Respondents could only tick one answer.

As the survey was conducted by charities with an interest in health and social care, this is reflected in these results. After the response ‘all/the general public’, the highest responses of the main beneficiary were for ‘other charities’ (12.6 per cent), ‘children and young people’ (10.6 per cent) and ‘older people’ (8.1 per cent). After these came ‘People with physical disabilities and / or special needs’ (6.9 per cent), ‘People with long-term conditions’ (5.9 per cent), ‘People with mental health needs’ (5.3 per cent) and ‘People with learning difficulties’ (5.1 per cent)

What groups of people does your organisation work with? (Please tick as many as apply.)

Who are the main beneficiaries of your organisations work? (Please tick only one.)

All/the general public 43% 24.0% Women 41% 1.4% Men 39% 0.2% Older people 41% 8.1% Children and young people 41% 10.6% Adults 46% 1.4% Families/parents 39% 2.6% Carers 39% 3.3% Employers 16% 0.2% People with physical disabilities and / or special needs 44% 6.9% People with long-term conditions 41% 5.9% People with learning difficulties 38% 5.1% People with mental health needs 43% 5.3% People from Black and Minority Ethnic communities 33% 1.0% People with a particular financial need (including poverty) 25% 1.4% Asylum seekers / refugees 13% 0.2% Homeless people 16% 1.2% People with addiction problems (e.g. alcohol, drugs) 22% 0.8% Faith communities 16% 1.0% Lesbian, gay, bisexual people 19% 1.4% Transgender people 16% 0.0% Socially excluded / vulnerable people 40% 1.8% Victims of crime and their families 11% 0.6% Offenders, ex-offenders and their families 18% 1.6% Unemployed people 28% 1.0% People experiencing domestic abuse 17% 0.0% Other charities, social enterprises and/or voluntary organisations 50% 12.6%

NAVCA Voluntary sector annual survey 2015 9

6. Services provided We asked “what services do you offer?” The responses are shown in the table below. Advice and guidance and information and support (57 per cent) were the most common answers. After those came volunteering (48 per cent), health improvement/wellbeing services (45 per cent) and training (37 per cent). Overall these results demonstrate that respondents represent the wider voluntary sector and deliver all the services that you would expect to be delivered by charities and voluntary organisations.

Which of the following services do you offer? (please tick all that apply) Adult social care 17% Heritage and museums 2% Advice / Guidance 57% Holiday schemes 7% Advocacy 34% Hospice / palliative care 3% Animal Welfare 1% Hospital / Inpatient 3% Arts and crafts 15% Housing 8% Befriending / mentoring 33% Independent living 16% Campaigning 29% Information and support 57% Capacity-building and support for other charities, social enterprises and/or voluntary organisations

29% International development (e.g. overseas aid, famine relief)

1%

Charity shops / retail 10% Lunch / meals 12% Community development / action 31% Mediation 3% Community facility / venue 23% Performing Arts 5% Community safety / crime prevention 9% Pre-schools / play groups 6% Community transport 9% Relationship support 9% Counselling 16% Residential / respite care 8% Day Centres 12% Self-help groups / peer support 26% Debt counselling 7% Sexual health support 7% Education 21% Social care 18% Emergency services 1% Sports and outdoor activities 12% Employment support/ vocational rehabilitation 16% Support for self-management 18% Environmental / recycling 6% Training 37% Faith groups 6% Voluntary and community sector

support 35%

Financial services 5% Volunteering 48% Fundraising 21% Youth clubs 10% Health care services 13% Prefer not to say 0% Health improvement / wellbeing 45%

NAVCA Voluntary sector annual survey 2015 10

7. Number of people helped We asked respondents to say how many people they helped each year. The answers to the question ranged from 5 to 1,300,000 and the median response was 1000. In total the charities and voluntary organisations that answered this survey say they support 7,986,050 people.

We recognise that helping people can be defined in different ways and obviously the support offered will vary enormously. Some charities responding will work intensively with small numbers of beneficiaries; others provide advice and information that is accessed by thousands. This question is not intended to get an exact figure but rather help give an indication of the reach of the organisations taking part in this survey. It shows the wide reach into communities across England that the respondents to this survey collectively have, and that they are representing people and communities across England.

Total number of people helped by organisations taking part in this survey

7,986,050

NAVCA Voluntary sector annual survey 2015 11

Section B: Views of Health services The next set of questions asked about the relationships that respondents had with local health services.

1. Responsiveness of local services Respondents were more likely to agree than disagree with the statement that local health and social care services are responsive to the needs of service users. However, respondents were more than three times likely to strongly disagree than strongly agree. Compared to last year the results are broadly similar and nearly half agree to some extent with the statement (47 percent). However, those somewhat agreeing with the statement is up and those agreeing or strongly agreeing down. When we compared the income of respondents to their response to this question, bigger organisations were more likely to agree with the statement.

Stronglyagree Agree

some-whatagree

Neitheragree

nordisagree

Some-what

disagreeDisagree Strongly

disagreeDon'tknow

2015 1.9% 9.7% 35.4% 9.2% 19.1% 10.2% 7.3% 7.3%2014 2.8% 11.8% 30.1% 9.0% 19.1% 13.7% 5.8% 7.7%

0%5%

10%15%20%25%30%35%40%

perc

enta

ge

Local health and social care services are responsive to the needs of our service users

Less than£10,000

£10,000 -£50,000

£50,001 -£100,000

£100,001-

£500,000

£500,001- £1

million

£1million-

£10million

Over £10million

Agree 34% 43% 39% 50% 49% 59% 48%

30%35%40%45%50%55%60%65%

perc

enta

ge

% agreeing that local health and social care services are responsive to the needs of our service users by income

NAVCA Voluntary sector annual survey 2015 12

2. Person Centred Co-ordinated Care We asked if the people with ongoing health and care needs that organisations work with are able to access person centred coordinated care and support. Responses were evenly split on this question. More work is needed to understand whether there are differences in the types of organisations that are agreeing or disagreeing with this statement. There does not seem to be a correlation between an organisation’s income and whether they agree with this statement. More work would be needed to understand whether the beneficiaries’ charities work for or the services they provide makes a difference their likelihood to agree with this statement. Although responses to this survey give us some information, they do not provide enough to draw out robust conclusions.

* This means people report “I can plan my care with people who work together to understand me and my carer(s), allow me control, and bring together services to achieve the outcomes important to me” (as described in the Narrative for Person Centred Coordinated Care).

Stronglyagree Agree

some-whatagree

Neitheragree

nordisagree

Some-what

disagreeDisagree Strongly

disagreeDon'tknow

2015 3.9% 7.8% 20.0% 14.4% 19.8% 11.7% 7.8% 14.6%2014 3.8% 7.0% 23.0% 15.6% 18.2% 12.1% 7.0% 13.3%

0%

5%

10%

15%

20%

25%

perc

enta

ge

The people with ongoing health and care needs that we work with are able to access person centred coordinated care and support*

Less than£10,000

£10,000 -£50,000

£50,001 -£100,000

£100,001-

£500,000

£500,001- £1

million

£1million-

£10million

Over £10million

agree 21% 41% 29% 27% 33% 35% 48%disagree 41% 36% 41% 41% 33% 48% 29%

10%

20%

30%

40%

50%

perc

enta

ge

Agreeing that the people they work with are able to access person centred care and support by income

NAVCA Voluntary sector annual survey 2015 13

3. Supporting service users Findings were more favourable about the role respondents were playing in supporting people using their services to play active roles in in their communities, service delivery and commissioning. Over half (56 per cent) of respondents said they agreed (either strongly agreed, agreed or somewhat agreed with the statement “We support the people who use our services to play active roles in in their communities, service delivery and commissioning”. However, there was less support for the statement than when we asked the question in 2014.

*(eg on pooling their personal (health) budgets; expert patients to shape experience and outcome measures and influence procurement; establishing user-led organisations and peer groups to quality-check services and provide peer support as integrated service offer).

Stronglyagree Agree

some-whatagree

Neitheragree nordisagree

Some-what

disagreeDisagree Strongly

disagreeDon'tknow

2015 17.3% 19.5% 19.0% 14.8% 9.4% 6.2% 2.2% 11.6%2014 15.1% 28.4% 19.3% 17.6% 4.4% 5.6% 1.3% 8.2%

0%

5%

10%

15%

20%

25%

30%

perc

enta

ge

We support the people who use our services to play active roles in in their communities, service delivery and commissioning*

NAVCA Voluntary sector annual survey 2015 14

4. Local health structures We asked whether respondents’ organisations have been involved in influencing local health and care organisations. Just over half (55 per cent) said that they had.

If they said yes we then provided a list of health statutory organisations and processes and asked which ones they had been involved with them. Respondents were most likely to have been involved with their CCG followed by their Local Healthwatch and Health and wellbeing Board.

Yes55%

No 45%

Is your organisation involved in influencing health and care structures and services locally?

JSNA CCG

Healthand

WellbeingBoard

LocalHealth-watch

NationalHealth-watch

Dept ofHealth

NHSEngland

Series1 39.3% 77.7% 57.1% 58.5% 9.4% 18.8% 31.3%

0%10%20%30%40%50%60%70%80%90%

perc

enta

ge

Please indicate which organisations or processes you have recently been involved with

NAVCA Voluntary sector annual survey 2015 15

We also gave respondents an opportunity to describe their experience in a few words. Themes that emerged include that the NHS seems vast, involvement is mixed or patchy across the different bodies, silos still exist and that there is a mismatch between intentions and reality. However a number of comments do indicate that it is getting better.

Here is a sample of the responses given.

“Generally we (the voluntary sector) have minimal influence over decisions made by statutory agencies and this is reducing as money becomes tighter.”

“Our experience would indicate that there is room for improvement in the way in which the voluntary sector and community are involved with commissioning. Current intentions and practice remain far from asset based or co-productive.”

“we are a part of the strategic panel with our local GP helping to shape the future of services provided in the area.”

“It is very difficult to achieve joined up working and efficiencies as all bodies are protective of their own funding streams. Also, statutory bodies need to understand that charities cannot deliver services at nil cost to the service user at all times - there is still a cost to providing services which has to be met from somewhere.”

“Mixed, good intentions but unclear structures make it difficult to engage especially with the CCG.”

“Exciting to see really innovative thinking with the community at its heart.”

“The area board has been supportive of our work in providing us with small grants for some of our services.”

“Generally good although the bureaucracy can seem rather top heavy and ponderous.”

“Challenging as NHS processes can appear to be overwhelming to smaller organisations.”

“Frustrating that silos taking so long to dismantle across health social care and public health despite so-called integrated commissioning.”

“Because we work with a rare condition awareness of needs is very low. This causes problems.”

“Positive but health and social care still work in 'silos'.”

NAVCA Voluntary sector annual survey 2015 16

Section C: Views of national initiatives We asked respondents about a number of national initiatives. We asked if they felt it had a positive, negative or no effect. Most respondents answered don’t know or not aware of it for most questions. What does this tell us about the impact of national initiatives? With so much competition for people’s attentions, it should not be a shock that there is a lot of ignorance about these initiatives. Some are not necessarily issues or policies that would have a wide reach among the public and promotion may be more targeted at specific audiences.

1. Not aware of it Personal budgets got the greatest recognition, only 10 per cent or respondents said they were not aware of them. NHS 111 and Change for Life came next. Both of these initiatives have had a lot of coverage so greater recognition would be expected. Around half of respondents were not aware of A millions futures: halving the disability employment gap, Crisis Care Concordat or NHS Change Day. This survey asked all respondents about the different initiatives, more work could find out whether the relevant people are hearing the right messages.

53%

52%

50%

49%

46%

45%

39%

38%

38%

33%

33%

32%

30%

30%

23%

23%

10%

NHS Change Day

Crisis Care Concordat

A million futures…

From evidence into action

Summary Care Records

Care.data

Friends and Family Test

Five Year Forward View

Francis report and government response

Health care integration

No Health without Mental Health strategy

NHS Constitution

Social value

Duty to involve

Change 4 Life

NHS 111

Personal budgets and personal health budgets

Not aware of it

NAVCA Voluntary sector annual survey 2015 17

2. Positive difference As well as respondents being aware of Change 4 Life it also got the highest number of respondents stating that it had made a positive difference (32 per cent) and the highest net positive impact of 31 per cent (calculated by taking away the number of responses saying it had a negative response from those saying it has had a positive effect). Personal budgets & personal health budgets garnered an interesting response as it had the second highest percentage of respondents saying it had a positive effect (24 per cent) but also the largest percentage saying it has a negative effect (17 per cent). NHS 111, which 14 per cent of respondents said had a negative effect, is the only other initiative which more than 4 per cent of respondents said had a negative effect. The percentage of negative responses for personal budgets and personal health budgets is interesting when considered alongside the high awareness respondents had of them. There would be value in understanding why this level of disapproval exists and whether there is any distinction between personal budgets and health budgets.

The survey also then asked about 4 non–health related national issues. These are dealt with in a separate report

0%

5%

10%

15%

20%

25%

30%

35%

Positive effect

Positiveimpact

net positive(% positiveeffect - %negativeeffect)

NAVCA Voluntary sector annual survey 2015 18

Section D: Biggest Issues We asked respondents to tell us the three biggest issues they are facing. We knew that funding would be the most popular answer so we asked them to add a few words on where the need is most pressing if this was one of their answers. The responses can be illustrated in word clouds.

Top three issues

Top priority

NAVCA Voluntary sector annual survey 2015 19

Funding was by far the most mentioned issue. In particular the uncertainty and the short term nature of funding. Other issues that received frequent mentions were the difficulty in recruiting volunteers, an increase in demand for services and the lack of understanding the statutory sector has of the voluntary sector. A selection of representative comments are below.

“Reduction in contract value from LA due to cutbacks. More work required for less funding.”

“Competing with much larger local and national charities.”

“Funding - mental health continues to be underfunded and an unpopular cause.”

“Recruiting and retaining sufficient volunteers.”

“Personalised budgets being set too low to give people choice.”

“Demonstrating the value of VCS services to clinicians, who will not invest in preventative services.”

“No easy access to funding from local authorities for small specialist providers.”

“Changing commissioning teams.”

“Mixed signals sent out by government towards those with disabilities.”

“Partners do not know how to work with small organisations.”

NAVCA Voluntary sector annual survey 2015 20

NAVCA is the national voice of local support and development organisations in England. We champion and strengthen voluntary and community action by supporting our members in their work with over 160,000 local charities and community groups. NAVCA believes that voluntary and community action is vital for vibrant and caring communities. We provide our members with networking opportunities, specialist advice, support, policy information and training. NAVCA is a vital bridge between local groups and national government.