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When it comes to the NHS, who speaks for Britain's voluntary sector?

It seems the British government is about to claim that the voluntary sector supports its plans to market the NHS out to "any willing provider". Those who actually give their money, time and effort to the voluntary sector should speak out against this if it isn't true.
Anthony Barnett
Anthony Barnett
12 June 2011

I want to start by saying that in terms of third sector organisations—charities and social enterprises—we are strongly behind the concept of “any willing provider”, because we believe that third sector organisations are an untapped resource that can provide a more cost-effective service and certainly a more citizen and patient-focused service. I see this as an opportunity for us to step up to the mark and expand what we do.

Stephen Bubb giving evidence to the House of Commons Health and Social Care Bill Committee, 10 February 2011

When the Coalition came to power, one of their claims to legitimacy was that by reaching an honest agreement between two parties with more than half the votes they were solving the loss of political legitimacy in Britain, which came to a head with the MPs expenses crisis of 2008. Finally, we would have honest government. But in his outstanding guest editorial in this week's New Statesman the Archbishop of Canterbury writes, “With remarkable speed, we are being committed to radical, long-term policies for which no one voted”. Far from being a resolution of Westminster's crisis of legitimacy, is the Coalition compounding it?

The NHS is at the centre of this profound argument. Does the proposed transformation of the NHS represents a democratic attack on costly bureaucracy that will make it more accountable - or does it involve its marketisation? This was the question I put to Nick Clegg in November. At the time he dismissed the suggestion, now he is going into reverse. But is there also a larger dishonesty of language in Coalition policy? Does the often attractive language of the ‘big society’, the need for ‘community’ and the ‘contribution of volunteers’ in fact mean the government is opening up public service to private profit?

One of the key mincing formulations here is that work should be done by “any willing provider”. Doesn’t that sound cuddly? Someone who is “willing” to “provide”. Why, it sounds like a form of charity, as in “Is anyone willing to provide the sandwiches?” In ordinary language it doesn’t mean can someone sell us sandwiches. To open up the NHS to “any willing provider” as Lansley intends sounds like looking for provision from hard-working charities. It could also mean opening it up to global corporations.

If what is happening is the masked marketisation of the public realm by a deceitful coalition then this strikes at the nature of our system of government. “At the very least, there is an understandable anxiety about what democracy means in such a context”, is how Rowan Williams himself puts it. Because of my interest in this I have been talking with those closely following the fate of the NHS. They alerted me to the fact that this week  Sir Stephen Bubb is going to be part of the Future Forum report back as part of the government's "listening exercise” on the NHS. He is going to claim that the whole voluntary sector strongly backs Andrew Lansley's proposal to open up the NHS to “any willing provider”.

It's likely that much will be made of his credentials as the representative of the voluntary sector because he is the CEO, the Chief Executive Officer, of ACEVO, the Association of Chief Executives of Voluntary Organisations. And has been for the last ten years.

Bubb’s enthusiasm for privatisation of public services is nothing new. It's certainly not the result of any "listening" he's been doing with Andrew Lansley over the past couple of months. As long ago as 2005,under Bubb’s stewardship, ACEVO was advocating a leading role for charities in the privatisation of services including prisons, children's services, and employment training – a position which the National Council for Voluntary Organisations warned could "warp public perception of the sector".

Today, he appears to have a severe conflict of interest, reported on in the Guardian, as he is Chairman of both the Adventure Capital Fund and The Social Investment Business Ltd

Bubb’s vision of charities as supporting and benefiting from the dismantling of the public sector is, surprise, surprise, popular with ministers. It’s probably why he was appointed to oversee the NHS Listening Exercise’s work on "competition and choice" in the first place! Could it have dampened his enthusiasm, that he was awarded a knighthood in the 2011 New Year’s Honours list for "services to the voluntary sector".

Who does Stephen Bubb really speak for? He has a right to hold his personal opinions however controversial. But is it legitimate for him to claim that he holds them as a representative of the "third sector", as he seems to have done when giving evidence to the Commons select committee back in February, as quoted above, and as he will almost certainly do again when announcing his report tomorrow?

ACEVO is a body for the chief executives of voluntary organisations – it is not the organisation of the staff bodies, let alone the millions of users, members, volunteers and direct debit supporters that make up the voluntary sector. The NCVO, the National Council of Voluntary Organisations, which has deeper roots across the voluntary sector rather than being the bosses network of the bigger agencies, is far more representative (including, naturally, of differences and tensions). The NCVO has been more critical of Andrew Lansley's NHS plans, its chief executive describing the original version of GP commissioning as "an absolute walking disaster".

But ACEVO’s claim to speak for even the CEOs of major charities is relatively weak. Membership of ACEVO is as much about accessing a range of perks including networking opportunities and discounted training courses as it is about having a representative voice. It seems unlikely that the Chief Executive of Friends of the Earth or the British Trust for Conservation Volunteers is backing Bubb if he stands up to advocate anything like Lansley’s vision for the future of the NHS.

The government spin doctors will doubtless do all they can on Monday to push headlines claiming that after “engaging” in a “democratic” NHS “listening” exercise, the voluntary sector has been "won over" to Lansley's vision. If so, they shouldn't be allowed to get away with it. From what I can make out, Stephen Bubb is a man who has long advocated breaking up public services and is still advocating breaking up public services. Maybe a number of chief executives of other voluntary sector organisations may agree with him. If so we need to know who they are and then we can make sure they ask their staff, volunteers, service users, and donors for their support before they speak in their name.

Bubb shows all the signs of being an example of a broader problem of charity capture. Chief executives of charities stake a claim to legitimacy based on the number of members, volunteers and service users they have. But little accountability exists between them and staff and supporters. Instead, what matters more to them is access to government. Chief executives of charities can be even more audacious than lobbyists for big business. It's rare for the CEOs of major corporations to claim that they are speaking on behalf of all their employees or customers. Even the tobacco industry goes to the trouble of funding front groups like FOREST that pretend to represent all smokers, rather than simply claiming they represent them themselves.

In effect, Stephen Bubb’s claim that he represents the voluntary sector’s support for a policy of  “any willing provider” in healthcare provision is an example of charitable astroturfing for government policies (the neat US term for the manufacturing of artificial ‘grass root’ support). In a hard economic climate, there's a powerful temptation for charity chief execs to cosy up to government in the hope of winning lucrative contracts or acquiring state assets at knocked down rates. Jonathan Porritt has already noted the compromised stance taken by many conservation charities towards the government's now aborted plans to privatise England's woodland. Or Clare Sambrook reported on the way Barnardo’s in effect traded their brand to participate in the government’s “alternative” to child detention, rather than campaigning against it.

Charitable groups can, sometimes do and certainly should give a legitimate and authentic voice in the democratic process to groups of people who wouldn't otherwise be heard. But this doesn't happen automatically. Instead, as the government reaches out to them with its contracts, all too often those like Bubb seek to be “cost-effective” service providers. In the process they may give ill-deserved legitimacy to the break-up of pubic services by marketisation, and they become another set of gatekeepers, claiming to speak with the voice of the people while actually managing and neutralising popular opinion.

We urgently need to challenge the credentials of those in the third sector elite who claim to be speaking for everyone else. Chief executives of charities who make false claims to be speaking for ordinary people when acting as propagandists for a market fundamentalist agenda need to be called out. Open campaigns like 38 Degrees are starting to do this in alliance with other campaigns, especially now that they are encouraging local meetings of everyone concerned about the fate of the NHS to deliver online petitions in person to MPs.

ACEVO claims to have over 2,000 members, although there is no list on their website. If you are a member, volunteer, donor, staff member, or service user of a charity which Stephen Bubb claims to be speaking for on Monday, maybe you should get in touch with the relevant chief executive and ask them whether Bubb is speaking on his or her behalf, let alone your own?

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