Dialogue, effective communication and trust are critical in the relationships between voluntary organisations providing health and welfare services and local government purchasers, according to a new study. However, these three critical factors are significant by their absence in the voluntary and public sectors' accountability to users of contracted services. This research identifies key accountability issues that the sectors need to address specifically in relation to users.
-- Changes in the external environment, which includes contracting, have led both the public and the voluntary sectors to recognise that they need one another. This interdependence has resulted in a balance in power relations between them.
-- However, there is a lack of accountability to users. It is more of an aspiration than a reality. There are many practical difficulties to be overcome and progress towards 'user accountability' is very slow.
-- Users' own concerns about services they are receiving include: being overwhelmed by too much information; feelings of intimidation and isolation; having to fight and push through organisational defences before they are listened to; and anxieties about complaining, in case of retaliation or withdrawal of services.
-- Organisations that are considered to be accountable to users by managers as well as users do not only have enabling structures in place but also have a management commitment to and an organisational culture of accountability. In these exceptional organisations, users' views are actively sought, as they are considered vital to informing and improving professional practice and service delivery.
In the 1990s changes in government policy for the provision of public services at local and national levels have raised new concerns about the nature of accountability. Health and welfare services previously delivered by the public sector are now being delivered by private and voluntary organisations from the independent sector. Contracting has therefore forced a new accountability relationship between the sectors.
Using in-depth qualitative case studies, this project examines: how public sector purchasers hold voluntary sector providers to account; how voluntary sector providers ensure accountability to purchasers and to users; and how users perceive and experience purchasers' and providers' accountability to them.
The relationship between purchasers and providers
Dialogue, effective communication and trust emerged as critical factors in accountability relationships between the voluntary and statutory sectors. These were especially apparent in the contractual relationship and in the on- going monitoring of service delivery. They were also evident in ensuring accountability through formal and informal networks.
The process of establishing the agreement through discussion and consultation was crucial. The negotiations forced the sectors to define and clarify their own role(s), limitations, strengths and responsibilities in relation to one another. Each was encouraged to be explicit about their assumptions and expectations of the new relationship. Although the 'learning curve' was steep and establishing agreements a difficult experience for both sectors, the opportunity for dialogue appeared to be vital to the marked shift in thinking given their new roles, and to the establishment of their 'partnership' and two-way accountability relationship.
Out of this contracting process came a clearer understanding of and mutual respect for the knowledge and expertise of the other. Both sectors came to recognise their need for each other and, above all, that they had certain aims, principles and values in common.
They are a funder but I think it is important that we don't just see them as someone who is benevolent giving us money. They are not doing it as a favour for us. ... We are answerable to them and we have to meet their criteria but they do have a responsibility themselves to this community as the local authority that is receiving money from central government to provide the services that this community needs (Voluntary Sector Manager).
Trust was a key element in the new relationship. With time, several levels of trust seem to have emerged.
-- Trust between organisations or sectors. This appeared to operate at many different levels - for example, between the trustees of the voluntary organisation and the local government commissioner of services, as expressed in and intrinsic to the contract/service level agreement.
-- Trust in the 'name' of the voluntary organisation:
... You have to make that initial assessment of the place and decide if they look trustworthy, and the place is fairly safe, and the procedures are in, and also the [organisation's] name - that helps. It's known as a good ... charity. (Voluntary Sector Manager).
-- Trust between managers in the two sectors. This appeared to operate at both an individual and professional level:
There is a feeling ... we are all going in the same direction and there is trust on both sides (Local Government Manager).
-- Trust between the users of a service and purchaser or provider organisations (in theory, if not in practice):
... I suppose there is another, the other level, whereby users need to be able to trust the [providers] and ourselves ... (Local Government Manager).
Accountability between purchasers and providers is ensured not only through the contract but also through informal networks - 'word gets around' (Local Government Manager), 'word would get back to us' (Local Government Manager) - and formal discussions at many levels throughout the various networks.
There were various ways of exchanging information, for example, through information technology, face-to-face contact, letters and publications, and at meetings (such as joint committees, working parties and panels, social events, such as car boot sales, fund-raising events, parties, in corridors, over coffee, in the pub, at lunch or on the telephone).
One important feature of the voluntary sector was variously referred to as the 'advisory group', the 'steering group', the 'management committee' or the 'management team'. These formal networks linked users' representatives to the purchaser, the provider and those from other sectors. These forums were used for 'consultation' and information exchange - 'free-flowing discussion', 'informing practice', 'debriefing', and 'lobbying'.
... we have our two main funders attend all the management committee meetings as well so they are able always to report to us on policy issues from their side that we need to be aware of. Often when a discussion comes up we'll actually turn to one of these people and say what is [your organisation's] line on this ... And also being linked in a way to large groups like that actually helps us to work out how to ... be accountable (Voluntary Sector Manager).
Voluntary sector respondents saw these groups, together with a number of other formal and informal monitoring meetings, as the mechanisms which reinforced their 'partnerships' with local government and 'contract accountability', their accountability to the local network and ensured the legitimacy of their activities.
... One of the reasons for these regular meetings is to make certain that things are on course and other people are happy with what you are doing ... . The fact that you are not just flying your own kite (Voluntary Sector Manager).
Unlike their public sector colleagues, who perceived a clear hierarchical line of accountability to the councillors, voluntary sector managers rarely (if ever) observed their line management accountability as extending ultimately to the trustees. For all voluntary sector respondents, most trustees (with one or two notable exceptions) were perceived to be not 'in touch', 'distant', 'paternalistic' and somewhere 'up there' [pointing to the sky]. Respondents felt trustees lacked relevant knowledge, or appropriate experience and understanding, about issues which managers dealt with on a day-to-day basis.
... one of the things I find extraordinary is that [the minutes are] circulated to Trustees about [this project], but the Trustees have very little insight into what is actually happening here, so I don't know how they can make any sort of real judgement, what they would base it on (Voluntary Sector Manager).
Again voluntary sector managers differed from local government managers in that their next level of accountability was 'to and through the local network' of other voluntary and statutory organisations. Finally, most voluntary sector respondents perceived that they were accountable to 'people who put the money in the collecting boxes'.
The relationship with users
All local government respondents said that they were committed to the concept of 'user accountability' but most reported that they were only at the initial stages of this process and considered user accountability to be 'uncharted territory' for both sectors. Despite the various attempts of managers in both sectors, the three critical factors (dialogue, effective communication and trust) were significant by their absence in the sector's accountability relationship with users.
All local authorities in the study reported that they were working towards user 'involvement' and 'participation in decision-making'. However, managers from both sectors and some users felt that the establishment of a new service and culture takes time, and that accountability to users is more complex than it may at first appear. Although both sectors had clearly made some attempts to involve and listen to users, most managers conceded that neither sector had been very good at really listening to date.
.. that's been much slower in happening than we had initially hoped just because it takes an awful lot to shift things, but that's still the intention ... I don't think we have got it sorted out terribly well either, so it's not for me to say the [voluntary organisation] haven't ... we haven't either (Local Government Manager).
We try. I am not always sure that we take as much notice as we should - but we do try (Voluntary Sector Manager).
Although users generally appreciated the services they were receiving, they had a number of concerns about accountability:
-- having to negotiate the alien organisational quagmire of jargon, systems, structures and cultures:
some of these things the jargon they use could mean totally the opposite to what I am thinking ... (User);
-- having to fight to be heard;
-- feelings of intimidation, isolation and being labelled as 'troublemakers':
at first it is very intimidating ... . It's very strange and when somebody makes you very aware that you've not done something right, that tends to shut you up for the next few meetings (User);
-- negative responses to feedback, which was perceived to be criticism and was not welcomed:
They have said that they felt criticised that you were criticising (User);
-- worries about raising issues in case of retaliation or the withdrawal of services:
I think parents would then feel that they can actually speak and not worry about what they are saying and not go home and think 'I shouldn't have said that - that could reflect on what respite I am going to get'. (User).
Only 2 of the organisations in the study seemed to have developed proper accountability to their users. These organisations not only had enabling structures in place, but were committed to user accountability as a two-way process across the entire service. In these organisations, users' views (whether negative or positive) were considered to be of tremendous value and were consequently encouraged. Users were not seen as critics or complainants and shared concerns were not thought of as admitting failure. On the contrary, user participation in decision-making was regarded as vital in informing professional practice and improving services. Managers in these organisations were also aware of, and some were even involved in user networks.
Accountability is from the organisation - to the parents and from the carers to the parents. Everybody has their own role/responsibilities, we know our role and are fulfilling our responsibilities. If there are any complaints from either the parents or carer they all approach the organisation to sort out problems (User) (Translated from Urdu).
In general between the sectors there is:
-- a balance in power relations because they are interdependent; * room for manoeuvre at a local level and conditions allowing for compromise and the creation of joint aims; * an increase in the bureaucratisation of the voluntary sector and a decrease and loosening of bureaucracy in the public sector.
However, the study identifies a lack of genuine accountability to users from both sectors. Contrary to the assumptions of many public sector managers, voluntary organisations do not necessarily have in place the mechanisms, structures or managerial ethos to ensure that they are automatically and inherently accountable to users.
The researcher concludes that policy makers and service deliverers need to address this lack of accountability to users as soon as possible. In particular, the public sector needs to recognise that user accountability does not happen automatically and that it is resource intensive with financial implications. Both sectors need to discuss with users how they can jointly facilitate user accountability.
About the study
The research was carried out by Sarabajaya Kumar based at Aston and South Bank Universities from 1994 - 1996. It involved detailed case studies of the relationship between two large charitable voluntary organisations providing health and welfare services, eight local government organisations purchasing these services and service users in inner city, urban and rural locations in England. Interviews were conducted with managers and service users. In all there were seventy-eight respondents. In addition to interviews, the research involved non-participant observation and documentary analysis.
The full report, Accountability in the contract state: the relationship between voluntary organisations, users and local authority purchasers by Sarabajaya Kumar is published by York Publishing Services (price£9.95 plus£1.50 p&p, ISBN 1 899987 45 2).
For further information on the study, contact Sarabajaya Kumar, CPSM, South Bank University, 103 Borough Road, London, SE1 0AA.