How We Did It: A Truly Person-led Service

From housing to recovery, councils are moving beyond traditional service delivery models by putting people in the driving seat. And it’s working.

In this instalment of our ‘How We Did It’ event series, Ben Hughes from Essex County Council shares his experience of setting up the Essex Recovery Foundation which is not only person-led, but community-powered, with former service-users integral to its governance.

Could you start by telling us a little bit about how alcohol treatment usually works in Essex?

Traditionally, the services have been commissioned by the county council – me, in an ivory tower, with a couple of members of staff and engagement from other statutory commissioners, trying to deliver and create a balanced drug and alcohol treatment system that fulfils the requirements placed upon us nationally, but which also addresses the needs of the local population and delivers outcomes as defined nationally and locally. Historically, we’ve got a budget, spent the budget, and tried to do the best we can by commissioning the appropriate services.

What were your hopes for the Essex Recovery Foundation and what have you achieved?

I took a view a number of years ago that the people that knew best and actually understood what was needed and what would work were probably the people at the receiving end of what we were doing. And I had in the back of my mind this bizarre idea that we could create a body owned by the community and hand over responsibility for the commissioning – and I mean commissioning in its broadest possible sense, not just buying stuff, but actually leading and developing a system. We could put it at arm’s length from us, we could invest the resources more effectively and actually get the services that would help the community achieve the outcomes that they were seeking.

We’d spent a number of years in the drug and alcohol world involving, consulting, and trying to work with the community. But it has always felt a bit tokenistic. Ultimately, we’ll ask their views – but are we actually listening? Are we actually doing what is meaningfully defined by the community? Co-production has become the buzz phrase of the moment, but what we’re trying to do is actually empower the community to drive the direction of travel, to create the strategy, to define the outcomes and then seek to achieve them. And really give the community the responsibility, the control and the power over how resources are invested for them.

The project has been going for six years – what are some of the highlights and successes?

The most important thing has been, together with staff within the legal department at Essex County Council, the commercial department, elected members and senior managers, agreeing a structure that was completely detached from the council. The most exciting moment – and it took us a year to explain to the Charity Commission exactly what it was we were trying to create – was the day that we got the charity registration number. It was one of those amazing moments, which I haven’t had many of in my career, where an idea that you’ve had has come to fruition. We now have a Board of Trustees that all signed on the dotted line around their responsibilities as trustees of a charity, and more than 50% of those trustees are graduates from our own treatment system, or people in recovery, or families of those people in recovery in Essex.

Along the way I’ve experienced a number of those sorts of Eureka, wonderful moments, including the day that the first drug and alcohol strategy developed by the charity was launched, published and signed off by the charity and then signed off by partners and stakeholders, because of course, the charity is leading the commissioning but equally, they can’t do it on their own either. So they are now learning to work with other partners across health, the Police and Crime Commissioner, other voluntary sector organisations, social care, and housing providers. They’re taking up the mantle of driving the strategy in that collaborative.

Among the Trustees, I have seen the light dawning that they can’t do it on their own and there isn’t enough money to do everything that they want to do, but I have also seen the excitement around the table over the fact that they have control over this and they have the ability to really influence where the investment is going. All throughout the journey there have been these moments where something has changed, the penny has dropped, and it’s just been superb.

We’d spent a number of years in the drug and alcohol world involving, consulting, and trying to work with the community. But it has always felt a bit tokenistic.

Could you tell us why you chose to go down the charity route and give us a flavour of some of the steps involved in the process?

We looked at a number of models at the very beginning. We looked at setting up a community interest company, and we looked at setting up a consultative board of the community. Throughout all of the discussions, we felt that an independent charity registered with the Charity Commission, so a charitable incorporated organisation, was the model that we wanted to look at because ‘charity’ is a word that resonates with the industry as an independent body doing the right thing, governed and overseen by the Charity Commission. It was also easier to create within the restrictions that being a local authority placed upon us at the time, and from legal advice that I got from Essex legal services.

One of the biggest problems we faced was that we weren’t setting up a charity that was going to deliver services, it was going to be a lead commissioning function. We were not simply setting up an organisation that would have money and then deliver a service or do something recognisable, we were setting up a charity that would take delegated responsibility for a function usually carried out by a statutory organisation. Explaining this to the Charity Commission took about a year. But I think the conversations with them were valuable, both to support them to understand what it was we were doing, but also to crystallise our understanding of what we were creating. All along the way, we learnt a lot more about where we were going, and what it was we were seeking to achieve. So it was helpful, if a little frustrating sometimes.

Something that was also very important was that whilst we were bringing the statutory partners that we commissioned with on board, we also took a decision to bring along some grant makers and funders. So at the very beginning, when I came up with the bizarre idea, we spoke to some large, national funders to start to socialise the idea with them, and to start to raise their understanding of what it was we were seeking to achieve. This helped because one of the first acts of the charity was to submit an application to the Big Lottery for core funding for the first three years to run as a learning experiment around empowering a community. And because we brought Big Lottery and others on board from day one, they had a very clear understanding of what we were seeking to achieve, and we were successful in getting quite a significant amount of money.

When something is new, innovative and exciting, it means there’s no precedent, or no way of demonstrating that it works. Could you tell us a little bit more about how you sold the idea to funders?

From very early on, as part of my budget, we’d always allocated money to community engagement, looking at peer support, developing the community and lived experience engagement. This meant we had a small pot of money that we used for some of the development funds. We worked with an organisation called Social Finance, who worked with the very early embryonic Board to help develop the processes, structures, policies, and all of the bureaucracy required.

We were banking quite heavily on some of the grant makers that we were working with from very early days to provide some of the core costs for the first few years. At the time, we had no idea that new money was coming down from the drug and alcohol world. So, we were sort of making it up as we went along and hoping that funders saw it as a learning experience for them as well because there was no precedent, nobody had done this before. Lots of people had done smaller, slightly different versions of empowering communities, but nobody on this scale, had decided that they were going to hand over responsibility and control of a fairly significant budget to the community. We were talking north of £9.5-10 million a year, on a recurring basis, being handed over to the community to define its allocation and spend. That money has gone up subsequently, and nobody’s got too frightened yet.

Another aspect that was quite key to grant makers and funders was that we were going to create an organisation that would focus commissioning around the community, meaning funders who were looking to put money into substance misuse services in Essex could part fund and work with us to coordinate their funding activity. So it enabled better coordination locally of monies that multiple funders were allocating, and meant that these funds were driven and defined by the community themselves.

Co-production has become the buzz phrase of the moment, but what we’re trying to do is actually empower the community to drive the direction of travel.

Outside of the council, who were you hoping to get involved? What kind of skills were needed and how did you go about building that capacity?

I’ve been commissioning drug and alcohol services since 2000, so I’ve been around the industry for quite some time. And I really just wanted people who had a passion for the agenda, a passion for giving back and had a real desire to see things done differently.

When I was the commissioning lead for drug and alcohol services in Essex, we set up a treatment provision across the county called the Community Rehabilitation Project where people in Essex would attend a residential programme for six to nine weeks on a daily basis, but they’d go home every day. And at the end of every programme, we would have a graduation where I’d turn up with a couple of staff members, plus lots of family, friends, and colleagues who worked with many of the clients on the programme. Everybody would get a chance to speak, I’d stand at the back blubbing because it was really quite emotional seeing how well people had become. And I’d get a chance to engage with people who graduated from the treatment system in Essex; they’d invariably started their journey with one of our providers, and they’d ended it through the community rehab provision. Through this I met people who really wanted to get involved. In fact, the person who is likely to be the new Chair of the Board was one of those graduates.

As well as the Board of Trustees, there’s a board called the Recovery Advisory Committee made up of drug users who are in recovery and treatment, or around the system, and the Chair of that committee is also one of the graduates that I met. So it’s been a case of spotting a couple of shining examples of recovery, asking them if they’d like to be involved, and then them going on and spreading the word, and they are now building the capacity of the charity to do its work.

The skills we were looking for were people who were willing to join in at the time – that was all it took. And there’s been a churn, people get involved and then they move on with their lives, and that is fine. Nobody is being forced to be involved beyond their comfort zone. We’ve now got 65 people in recovery involved in the Recovery Advisory Committee and the Board of Trustees, and they’re just building and building on a constant basis. It’s people who want to be involved, people who are willing to engage and people who are building their understanding of how this is done. I think it’s people who get excited the same way as I do about things working just one little bit better.

All throughout the journey there have been these moments where something has changed, the penny has dropped, and it’s just been superb.

The thing that strikes me is just how relaxed you are about handing over authority and being completely open to what the charity decides to do next. How have you managed to be comfortable in the unknown?

Probably because I understand the agenda. I’ve been doing this for a long time. Before I was a commissioner, I was providing services in prisons, so I’ve been around the agenda for quite a long time. But we are still on a journey. For example, we’re getting new funding from the government which requires the charity to fill in a vast amount of bureaucratic nonsense to get those grants handed over. So we’re having to support them to do that side of things. We started off, when we set up the charity, with a view that we would hand over the money every year, we’d transfer contracts across to the charity and they would hold everything and it would all be theirs. When the chief executive of the charity, Lawrence, was recruited, his first comment was: please don’t transfer that money to us, because the minute you transfer £9.5-10 million, the audit processes will go through the roof and we will have to recruit staff to devote their time to simply creating our accounts and auditing them. So rather than handing over the money in the contracts, the charity now contracts me and my team as their Commissioning Support Unit.

We didn’t know that was going to happen from day one, we had an idea of how things would happen, but what it’s turned out to be is a far less risky because the money still sits at the county council, and contracts sit with us. As their Commissioning Support Unit, we are simply the people who do the work that they want done, in the same way that the health sector had Commissioning Support Units supporting strategic boards.

“Everything will be alright, in the end. If it’s not alright, it’s not the end”.

We know there’s new money coming down, we know that the government have been slow about allocating it, and we know there’s some uncertainty – but actually, it’s alright, because there’s lots of other work we can be getting on with. There’s a quote I really buy into that around this agenda: “everything will be alright, in the end. If it’s not alright, it’s not the end”. We worked very hard at the beginning to work out what the risks were, and the risks were that the charity might not work. Okay, if the charity doesn’t work, we just go back to the old way of doing things and look at a different way of engaging the community. Nothing’s been lost, apart from a lot of hard work and a relatively little bit of setup cost. But what we’ve gained is an understanding of how to do this better and the ability to work with people to enable the community to influence this agenda. It’s alright to live with the uncertainty, because as long as we’re all trying to go in the same direction and achieve the same objectives, the uncertainty can be managed.

What advice would you give to someone else who was thinking about developing a person-led service?

Do it. Do it straight away and don’t delay. It’s been the most rewarding thing I’ve done in my life, career wise. It’s absolutely the right thing to do. And you don’t have to choose between creating a charity or nothing at all. There are some really good publications – and I’m going to big up New Local here – that I’ve looked at from day one, which are Community Commissioning and The Community Paradigm. There are a spectrum of organisations and functions you can create to empower a community, you don’t have to go all the way to arguing with the Charity Commission about what it’s all for.

But I would say if you want to empower the community, if you want to develop a process whereby the community has control and things are led by the community for whom the benefits will accrue – do it, just go ahead. This has taken me six, nearly seven years, but it’s been worth every painful moment sitting in an office with legal services.

Ben Hughes is head of wellbeing & public health at Essex County Council. You can find out more about the Essex Recovery Foundation here

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