Charities Providing Care Report: The Regulators

Published 8 January 2020

Charities must be able to demonstrate to regulators that they have strong systems in place to ensure they identify and act on safeguarding issues, and can collect and act on feedback from clients to ensure services are improved.

The CQC’s assessment framework makes it clear that providers must introduce effective arrangements for managing safeguarding, complaints and feedback from clients, and how this will feed into their quality and risk assurance arrangements.

The framework explains that providers can get assistance in developing these systems from the National Institute for Health and Care Excellence (NICE), Skills for Care, Skills for Health, The King’s Fund and a number of other sources. “They supply extensive advice and guidance, including on good safeguarding and safety practice and all other aspects of providing good standards of care and support,” an official at the CQC says.

The CQC says charities must demonstrate their feedback systems enable the involvement of service users when considering lessons learned, and take part in “iterative, co-produced improvement” of services.

The Charity Commission expects charities to deliver their charitable work “not just through their activities, but through their behaviour too”. A spokesperson explains that “managing complaints and concerns appropriately, reporting serious incidents and being honest when things go wrong is an intrinsic part of this approach”.

The Commission also expects to see trustees taking a proactive approach when needed, “strengthening their safeguarding policy, for example, or creating a new approach to fundraising to afford donors more care”.

COLLABORATION IS KEY

Dixon wants the Charity Commission and the CQC to have a more joined-up approach to information gathering, so that charities do not have to duplicate the information they are required to provide.

She stresses that “good safety and governance cost money”, adding: “When the NHS and local authorities are commissioning us, they need to make sure that there is enough money in the contract to provide for the cost of robust safety and governance systems and training.”

Ospedale feels that the March 2018 Haiti sexual abuse scandal involving Oxfam was “a wake-up call” for the Charity Commission. “From that perspective, the Commission is beefing up the effectiveness of their regulatory duties,” he says.

He feels there should be more consistency between the CQC and the Charity Commission as to what is defined as a serious safeguarding incident.

“It would be good if the two bodies got to a point where they could say ‘this is what we commonly see as a serious incident’ rather than people doing one thing for one regulatory body and one for another,” he says.

In response, the Charity Commission says that, in relevant cases, it works closely with the CQC to share information and resolve concerns – prioritising the needs of the case and the individuals involved. “To formalise our way of working, we are in the process of preparing an MOU [memorandum of understanding], setting out the terms of our joint working,” a spokesperson says.

However, the CQC says safeguarding arrangements and alert thresholds are managed by local authority safeguarding teams, which are responsible for local implementation of national guidance and codes of practice.

A spokesperson explains that “safeguarding teams typically provide or signpost training and development opportunities for services in local areas. We are not currently involved in determining thresholds with the Charity Commission”.

The CQC adds that “commissioners and providers need to be clear and distinct about ‘serious incidents’, ‘serious safeguarding incidents’ and ‘safeguarding’, which may not be one and the same”. The Charity Commission expects trustees to report serious incidents in line with its guidance, even if this has also been reported to another regulator such as the CQC or even multiple other regulators. “This is essential to assess trustee handling and determine if our intervention is needed. It also builds our understanding of risks facing the sector so we can identify and produce the information and tools needed to help charities succeed.”

CONSISTENCY ACROSS SERVICES

Organisations providing services on multiple sites or in remote locations have a particular challenge in terms of compliance and safeguarding, which must ensure that staff, clients and families are free to report concerns.

The charity Leonard Cheshire employs more than 5,000 staff, has 10,000 volunteers and supports over 50,000 disabled people across multiple sites in the UK and internationally. It has introduced a ‘Safeguarding for All Framework’, which is about having an appropriate focus on preventing problems, the appropriate response when problems arise, and very strong governance and organisational learning.

“Those are the three fundamental pillars of safeguarding,” says Chief Executive Neil Heslop, “and within that having lots of routes for feedback to the organisation, whether that be through independent whistle-blowing lines, management oversight, listening to customers in a very structured way or staff surveys. All these are rich sources of insight, and smart leaders make sure that all insight is available to help them deliver.”

As well as standardised consistent training, Alzheimer’s Society has systematised its approach to safeguarding alerts and reports through an IT system called Radar. The system records all alerts and is monitored by a safeguarding and quality team.

Campbell explains: “One of the things the team looks for are any areas where we are not getting any safeguarding alerts raised – that is always a trigger. You would expect, even if in the end they turn out not to be a safeguarding issue, that people would be hearing things that made them wonder if it was.”

Hunter says in remote locations it’s vital to have clear procedures that are “heavily rehearsed” so that staff understand them. “While these may be national organisations, staff must be brought together at regular intervals for workshops and seminars, for example, so that practice can be compared, contrasted and developed.”

To ensure safety and good feedback from remote sites, Dixon says organisations must nurture leaders at every level and avoid a blame culture. She adds: “They need to give people the confidence to report because they know it won’t mean ‘off with their heads’.”

Dixon adds that senior managers must have a presence across the organisation. “If I walk into one of PSS’s services, people know who I am and how to get in touch with me,” she says.

Where services are provided remotely, Ospedale says it is important to have checking and auditing procedures in place such as regularly getting feedback from the people receiving support.

United Response carries out an annual survey of the people it supports and their families, which offers another opportunity to raise complaints or compliments. Ospedale says he was alert to the danger that complaints and feedback collection should not come down to “an exercise in quotas – your organisation is of this size, so you should have this number of complaints and this number of compliments”.

DAC Beachcroft Partner Alistair Robertson stresses the importance of strong data infrastructure, which can sometimes feel like a ‘nice to have’ for cash-strapped charities, but which is vital to limit the risk of safeguarding failures. “Large and geographically diverse organisations can lose grip on what they are doing if they do not have a really strong data reporting system and rely on multiple databases. Skimping on this can be a real false economy. Ultimately, combining evaluation reporting and safeguarding reporting into a single set of mechanisms (and numbers) would drive real grip over an organisation’s activities.”

He adds there are also challenges associated with a trend towards charities devolving power and processes away from head office and out into the community, as touched on by Ospedale. “In order to build maximum impact and be safe as an organisation, the charity has to be able to collect and evaluate the data produced by all that devolved activity – this can be more complex when you don’t have direct levers from the centre,” Robertson says.

MEASURING IMPACT

The regulators are also interested in how effectively charities are measuring their impact. The best practice guidelines in the Statements of Recommended Practice describe how charities should prepare their accounts, which includes a provision about measuring impact.

Organisations such as the Charity Finance Group and New Philanthropy Capital, meanwhile, offer paid-for advice and guidance on how to go about impact reporting, but the Commission says it is for trustees to determine what fits best for them.

The Commission describes impact reporting as “an expression of a charity’s understanding of the difference it makes”. A spokesperson says: “It’s important for charities to ask these questions of their work and valuable for the public in understanding how the money they give makes a difference.”

Heslop says the Leonard Cheshire charity thinks about impact in terms of formal outcomes-based performance measures, but also considers how the charity does things. “Much of that is about the behaviour we expect of people as colleagues or managers. Those two things have equal weight.”

Working for a charity, Heslop says he has a range of audiences, including regulators, commissioners, communities of staff, and volunteers. It also includes the community of people it serves, and the wider community around them such as family and friends, educators and social workers.

“All of those different communities for us are of equal value and we work very hard to make sure we have opportunities to listen and test the temperature of what each of them is feeling about us.”

Hunter says good impact reporting comes back to the key theme of co-production. “If you have people at the sharp end of what you do involved at every stage of the service, design, delivery and evaluation, then you have a ready means of seeking to examine impact,” he says.

Key performance indicators (KPIs) and focus groups also play a part. On the campaign side, Hunter says impact is measured in terms of media headlines generated and appearances before select committees that may contribute to legislative change.

Dixon says KPIs go to the PSS board every quarter, as well as a separate report containing feedback from staff and people who use services, in addition to management responses to any concerns raised.

At a recent Charity Commission event, Dixon stressed the importance of charities being honest and open about where they have made a difference and where they could do better.

But she also made a request of the regulator to be more supportive. “We must be prepared to show the impact we are having as we receive public and other funding, but we need reassurances that it will be received in the right way – otherwise there is a danger that we will simply be telling them only the good news, rather than being more honest.”

Robertson says: “The link between impact measurement and safeguarding is that they are both all about evaluating the service provided and extracting data from that, and using that data to measure the three key things that charity trustees must know:

1. is the charity making a difference?

2. is the charity behaving appropriately [the ‘how’ referred to by Heslop above]

3. is the charity keeping people safe?

It is vital to have strong systems in place to ensure success in both impact measurement and safeguarding.”

Click here to download ‘Charities Providing Care: Leadership, safety and governance’ in full.