Context of work package 1
This chapter details the findings of the first stage of the PROSPER study. This was an exploratory qualitative study carried out with victim-survivors, VSS service practitioners and commissioners of services for victim-survivors. The aims of this part of the study were:
- to develop understanding of the principal issues shaping the delivery, funding and commissioning of VSS services and the unique features of these organisations
- to use the findings to inform the development of three national surveys that will map the provision, funding and commissioning of VSS services.
Methods
Please see the previous chapter for details of how this study phase was conducted. The following sections of the chapter detail the qualitative findings, organised around the themes of (1) the uniqueness of specialist services and (2) funding and commissioning issues and experiences. The final section of the chapter identifies the key messages from this study stage. We have used illustrative participant quotes in this chapter, all of which are presented using pseudonyms to protect anonymity.
Findings
The uniqueness of specialist services
When describing what made VSS services unique, practitioners and commissioners frequently spoke about the nuanced, specialist knowledge and understanding that service staff had about SV and trauma. This, typically, derived from specialist training and/or working in the field for many years. Frequently, VSS services were associated with offering an environment dedicated to victim-survivors, where myths about SV were challenged and a safe space was created for people to meet and share experiences and understanding. This dimension of VSS service provision was consistently and highly valued by victim-survivors: ‘It’s (being in a group of peers) like a solidarity, that you can’t explain and you don’t need to speak about it, it’s just there’ (Female victim-survivor 3).
Mission, values and ways of working
The mission and values of VSS services also shaped how they supported victim-survivors and distinguished them from other providers. Broadly, VSS services were characterised as promoting a holistic, needs-led approach alongside a philosophy of empowerment. This was in contrast with more clinically focused services which tend to be focused on individual rather than population (or social) changes and interventions. Underpinned by a critical understanding of gender inequalities and, in many cases, feminist philosophies, VSS services also worked to advance explanations of trauma and abuse that are rooted in structural understanding of SV. The promotion of an understanding of SV within a political, cultural and social framework was part of the work that happened with victim-survivors.
By supporting victim-survivors to understand the wider factors that shape how society understands and responds to SV and abuse, specialist services sought to empower victim-survivors and reduce feelings of responsibility and self-blame. In the following extract, a practitioner describes their organisation’s ethos of supporting victim-survivors in this way:
We don’t focus on, when people come to us and tell us they’ve been diagnosed with a mental health problem, we kind of usually look at them and think actually, tell me a bit about what your experiences are. Let’s forget what you’ve been diagnosed with.
Practitioner 8
As an expression of these values, workers prioritised building trusting relationships with victim-survivors, founded on a clear belief in their experience of abuse/violence. Victim-survivor participants identified that feeling believed made a critical difference when engaging with VSS services, fostering trust with practitioners and alleviating deep-seated feelings of isolation and shame. Given that many victim-survivors described the process of seeking support as long and complicated – and often taking place many years after they had experienced abuse or violence – the experience of being believed could mark a turning point in their personal journey or recovery:
I was always worried about, you know, people are going to say ‘well no, it didn’t happen. Why have you waited so many years for this to happen?’ So to be able to speak to somebody and to build up that little bit of trust with somebody was absolutely massive.
Male victim-survivor 3
Voluntary sector specialist services’ responsivity and capacity for innovation
For the most part, VSS services were characterised by participants as demonstrating responsivity and the ability to adapt to emerging needs and challenges. For example, creating new services when needs arose, or reconfiguring services to meet new funding requirements or commissioning specifications. VSS services also had a reputation for developing new approaches and creative forms of support when working directly with victim-survivors, as described by this commissioner ‘The voluntary sector is much quicker to be able to respond to things aren’t they because they don’t have all the bureaucracy that a health trust may have, for example.’ (Commissioner 3).
A number of factors allowed for this responsiveness. Combined with an ethos to empower victim-survivors and to amplify their voices, VSS services were frequently described as less hierarchical in structure, with victim-survivors embedded into the different levels of the organisation and volunteers making up a critical part of the workforce. In addition, many VSS services had a strong history of working closely with victim-survivors (a ‘co-produced approach’) to shape the design and delivery of services ‘We have victim-survivors that work here at all different levels from the management to trustees to staff and I think there is something about having that shared knowledge.’ (Practitioner 8).
As an expression of this reciprocity, VSS services were widely regarded as having reciprocal connections with their local communities. This enabled them to pick up on emerging trends and changing needs amongst clients and to incorporate this knowledge into the delivery of services quickly and adeptly. Close relationships and proximity to local communities also contributed to their credibility amongst diverse groups.
Accessibility and duration of support
As noted, VSS services were characterised as responsive and person-centred in their approach. For many services, this meant being accessible at the point of need and, in turn, limiting the use of eligibility criteria. This approach went hand in hand with working at the pace of victim-survivors, that is, not being only outcomes focused or inhibited by ‘arbitrary timescales’. In a climate of increased demand and limited resources, practitioner participants nevertheless consistently voiced concerns about their ability to protect and maintain certain services, particularly those that offered longer-term support. Over the past 5–10 years, many services have seen a reduction (relative to demand) in funding and/or commissioned contracts for therapeutic provision, with the aim of investing in practical and emotional support services instead. The intention of this change in approach is to free up practitioners’ time so that they can better support a greater number of victim-survivors to access and ‘move through’ services in a timely manner. Yet, participants explained, waiting lists were at historic highs in many areas and victim-survivors continue to face delays. This meant that, in some areas, the drive to create more responsive, streamlined services risked creating a ‘revolving door’ effect (Practitioner 6). This resulted in victim-survivors needing to access services multiple times when seeking support and undermined the national policy promise to provide lifelong care to victim-survivors ‘On the one hand we’re giving the message “speak out” and on the other hand we’re saying – excuse my French – “shut the **** up”.’ (Practitioner 13).
Victim-survivor participants attested to the negative impact of waiting long, sometimes protracted periods (several months, sometimes years) before receiving appropriate support. They also talked about the emotional burden that ‘fighting’ for support had placed on them, particularly when they were in a mental health ‘crisis’ (Male victim-survivor 3) or ‘at a very low point’ (Female victim-survivor 6). In response to these challenges, VSS services often went to considerable efforts to provide alternatives for victim-survivors waiting for therapy and counselling. For example, by developing new support groups and resources (online support, self-directed courses) that victim-survivors could access while waiting for counselling or therapy; or, by managing the waiting lists so that people who required support beyond the specified set of counselling sessions would be able to return to the service without experiencing adverse delays. However, several commissioners raised concerns about how this laudable commitment to support everyone on a needs-led basis could lead to high, unsustainable workloads for voluntary sector staff teams.
Distinctions and relationships between statutory and voluntary sector services
We asked participants in all groups about the perceived strengths and limitations of VSS services and the ways these services worked together to support victim-survivors. It was widely recognised that differences in approach stemmed principally from the different agendas and responsibilities of organisations within each sector. Statutory services were often regarded to be less agile, less responsive and less able to innovate because of their additional administrative and decision-making structures. Echoing other participants, statutory services were described by Participant 11 as ‘a ship that takes a longer time to turn around’.
Against the backdrop of these wider, structural issues, participants tended to characterise statutory provision as working less well for victim-survivors, particularly when it was non-specialist (e.g. mental health services, social care). These limitations were attributed to the legacy of historic injustices and/or poor care by some statutory institutions, particularly for marginalised groups, for example, sex workers and people from racial and ethnically minoritised groups.
A further barrier was staff often not having detailed knowledge and/or specialist training about SV:
it’s the societal context, isn’t it, of sexual violence and understanding kind of the impact on the person and their sense of self which maybe wouldn’t get as nuanced within a mainstream mental health service, it might just be focused on trauma.
These factors led to a perception that statutory practitioners were less likely to explore issues of abuse with victim-survivors, resulting in ‘missed opportunities’ for support and intervention. Observations were also made by victim-survivors about the difficulties finding specialist services in some areas and the limited knowledge that professionals in other (often statutory) services had about VSS services, which further delayed accessing appropriate support ‘I actually stumbled across it [VSS service] so therefore that’s how I came across it, that’s how I found out. Obviously, I self-referred because my GP didn’t know anything about it.’ (Female victim-survivor 3).
Issues of risk and vulnerability were also seen to be handled differently. VSS practitioners emphasised, for example, that they sought to work closely with people to enable and support them after disclosures of abuse, and offered holistic support, irrespective of the level of perceived risk or vulnerability. There was also a perception that VSS services would focus work on empowering women to make disclosures to statutory services rather than doing so on their behalf. These factors contributed to the view that VSS services facilitated a more trusting relationship with victim-survivors and creating a greater sense of safety when accessing their services ‘If there’s a safeguarding issue the voluntary community sector would have to make that safeguarding referral, but I think there’s just a perception that they’re more supportive and protective …’ (Commissioner 1).
Despite these differences, many examples were given that underlined positive, productive relationships between voluntary and statutory organisations. There were also examples of innovative partnerships being developed between services (e.g. with mental health and children’s social work) and accounts of victim-survivors receiving effective responses from all agencies. Most VSS practitioners spoke of effective, if not close, working relationships and linkages with their local SARCs and individual workers were seen to play a key role in effecting changes in interagency relationships and offering tailored support that recognised the particular needs of victim-survivors. The implication being, however, that while ‘good’ working relationships were valued, this was not the experience with all colleagues in partner organisations:
We have some fantastic police officers that we work alongside and then we have some police officers that are frankly dreadful but that is exactly the same again really in social services … So it’s varied, to be honest.
Organisations in both sectors were facing similar challenges meeting increased demand for their services without an increase in their funding and infrastructure. This had led to a situation where VSS services were increasingly working with ‘complex’ and ‘high-risk’ clients who would have previously been offered ongoing support from statutory services (mental health, social care). In turn, this had blurred the conventional lines of responsibility between some organisations, with the voluntary sector often left ‘picking up’ support that statutory services no longer carried out (due to higher thresholds to access support and stretched staff). When VSS services, ‘stepped in’, however, they often did not receive a commensurate rise in funding ‘There’s quite a lot being put on the shoulders of a third sector organisation that they shouldn’t, there’s levels of risk and complexity that they shouldn’t have to be shouldering.’ (Commissioner 8).
Given the complex and shifting nature of how services operated, several commissioners cautioned against overemphasising the difference between statutory and VSS provision. For example, citing the comparable levels of commitment and passion of statutory sector staff. For others, it was important to recognise that there were good and not so good services in both sectors and that the emphasis should be on improving support for victim-survivors across the board.
Funding and commissioning issues and experiences
Evolution of the funding and commissioning of voluntary sector specialist services
Over the past 10 years, the way VSS services are funded by public sector institutions has evolved from a predominately grant-based approach to a commissioned contract model. This has brought about changes in the relationship between services and the bodies that fund and, increasingly, monitor and influence their work. It has also ushered in significant changes in how VSS services are organised and, in some areas, how they work with one another. The evolution of these VSS services was typically characterised as ‘Starting off very much grass roots, volunteer run, and then expanding, diversifying services, diversifying income and professionalising more and more staff members and [having] fewer volunteers.’ (Practitioner 4).
However, amongst the practitioners with whom we spoke, the services they ran and worked for were at different stages in their familiarity with the commissioning process and had varying perceptions of its strengths and limitations. It was also evident that practitioners had different experiences of working with local commissioners. While some VSS services were embarking on their first round of tendering for a commissioned contract, others had considerable experience of the process and in working with different commissioning bodies. This speaks to the range of experiences across the sector and across the country regarding to the use of commissioning.
For commissioners, the move to a largely contract-based model was typically considered positive. Participants shared examples of the impact that commissioning had had in fostering new partnerships between services, cost saving and driving up the quality of support to victim-survivors. In a context of reduced public sector finances, the commissioning process was seen as a useful way of improving efficiencies, in part through the competitive tendering process.
Both commissioners and practitioners spoke about the drive for commissioners from different public sector organisations to pool their budgets and offer longer-term, larger contracts across wider regional areas. This was part of a gradual move towards joint commissioning approaches: wherein commissioning organisations collaborate and share responsibility for how services are designed, delivered and identifying their required outcomes. Joint commissioning can involve organisations working together at all stages of the commissioning process, or just some key stages; it can also involve the pooling of different organisations’ budgets. Joint commissioning approaches are also associated with cost savings (e.g. through efficiencies of scale) and, as several participants argued, promote a greater level of transparency and accountability about what each partner body was doing in respect to SV. Given the historic inconsistencies in funding of services for victim-survivors, this aspect of joint commissioning was considered to be particularly advantageous, as expressed by this senior commissioner:
There has to be, to my mind, a reduction in variation because you can’t keep commissioning small amounts of niche services that add up to a totality because actually, they’ve also got requirements with public money to deliver services to everyone.
In addition, joint commissioning was seen to be the principal way to introduce more streamlined and productive solutions to current, complex commissioning landscapes locally, with the aim of building a more ‘whole-system’ response.
Practitioners expressed concern that in the process of ‘scaling up’ the size and value of contracts for VSS services, the larger organisations, which tended to be non-specialists and/or private providers, would be attracted to bid for contracts and thus be in competition with smaller, VSS services. These larger services were also seen to be better placed to competitively tender for larger contracts because they had the infrastructure (e.g. finance, marketing, bid-writing personnel) and larger incomes that could be used to offset initial start-up costs and offer assurances to prospective commissioners.
Consortia, collaboration and competition
In a number of areas, VSS services had formed, or were in the process of forming, consortia or formal joint working arrangements with one another. It was clear that most partnerships tended to develop in response to a commissioner-led agenda, including a drive for greater consistency and less burdensome administration processes:
[Consortia arrangements] make it easier for the commissioners to deal with because, we like that kind of partnership working and the richness of experience that they bring as a number of organisations. But if we were to commission each of them individually, that’s a lot more work …
The pooling of smaller organisations’ resource, expertise and, in some cases, infrastructures also enabled these VSS services to credibly challenge larger, generic providers in the tendering process (as discussed above). For practitioners, partnership arrangements had sometimes helped to reduce a sense of competitiveness for funding and enabled more open conversations about ‘joined-up’ approaches to tackling shared strategic challenges. The sharing of resources, the streamlining of referral pathways and the delivery of shared training also brought tangible benefits. However, there was a sense amongst many (although not all) practitioners that they had entered into partnership arrangements principally for pragmatic reasons and felt that their ‘hands had been forced’.
For commissioners, successful consortiums had enabled VSS services to protect and develop their work by joining with other specialist centres and, in some cases, partnerships were attributed with enabling diversification and creativity in these services. Commissioners were, in general, keen to promote greater use of consortia and partnership agreements and to actively support smaller voluntary sector organisations engaging in the process. Examples were given of commissioners providing independent consultants to facilitate change management processes and to help ‘match-make’ smaller and larger organisations so that they could explore potential partnerships. Training and information-giving was also seen as a key part of the upskilling process of smaller organisations and some commissioners had awarded dedicated pots of funding to focus on ‘transforming’ service delivery and organisation. Indeed, there was a sense amongst many commissioners that over the past 5–10 years ‘We have put quite a bit of time and effort into building the local voluntary sector and capacity capability.’ (Commissioner 9).
However, several commissioners emphasised that it was ‘not enough to put on a few workshops’ (Commissioner 8) and that commissioners had to play a lead role in promoting and developing local voluntary sector capacity if they were to compete for contracts on fairer terms. It was also recognised that consortia were not without their challenges. The legal complexities in developing consortia were very real, so too the practical issues involved in managing more complex organisations. Several commissioners discussed how larger VSS services tended to shoulder the burden of this administrative work and there was an inevitable inequality to some partnerships.
Co-production and partnership in the commissioning process
For practitioners, power dynamics and inequalities shaped their interactions with some commissioners. A number of practitioners had faced negative, disempowering experiences of the commissioning process and/or with some individual commissioners. However, practitioners’ experiences varied and there were several examples of productive, positive working relationships with individual commissioners. ‘Excellent’ commissioners were typically characterised as being committed to, and advocates of, the services they commissioned. Underpinning these relationships was a sense of being trusted and their expertise being valued: ‘The relationship is absolutely key and being listened to and being seen as an expert’ (Practitioner 3). Commissioners who made an effort to understand the work being carried out – that is, through regular visits, ongoing conversations, meeting with service users – were singled out by practitioners as positive examples. These commissioners were seen to make more informed decisions and, resources permitting, to be more willing to invest in VSS services, including covering costs beyond those of ‘direct’ service delivery.
The flip side of positive working relationships was the insecurity generated by poor ones, where communication and shared understanding were lacking. Several practitioners commented on the ‘personality-driven’ nature of decision-making within the commissioning process and the lack of redress available to smaller organisations who lost out on funding or disagreed with approaches to monitoring and review ‘Sometimes it’s very personality driven, you know, those decisions are made not always based on need, but actually because of a relationship between the funder and a chief exec. It’s really not a transparent way of doing things.’ (Practitioner 4).
Power inequalities also surfaced in the commissioning process itself. A common source of frustration was the limited involvement of victim-survivors or VSS service workers in the development of service specifications. The process was described by some practitioners as feeling ‘top down’ and involvement was described as superficial. An absence of collaborative working at the service specification stage was also perceived to be associated with the development of services that did not meet victim-survivors’ needs. For example, the imposition of short-term, time-bound support was seen to undervalue the role and impact of counselling provided by SV specialists. Short-term, support-focused provision was also associated by some practitioners with clinically orientated ideas about the quick reduction of mental health ‘symptoms’ rather than the provision of holistic, trauma-informed care ‘Commissioners, they would like it just to be neat and tidy – ten therapy sessions. That will be, that’s all that is necessary. Of course, that’s ridiculous.’ (Participant 1).
The importance of providing integrated, consistent support was a concern raised across the participant groups, not least by victim-survivors who reflected on the impact of feeling they had been ‘bounced’ between services or that long-awaited therapeutic support had ended prematurely. To address this, some commissioners advocated that service specifications should be co-produced and that commissioners should have greater knowledge about victim-survivors’ needs and issues. Commissioners also highlighted the importance of improving feedback mechanisms throughout the commissioning process so that the views of VSS staff and victim-survivors were consistently understood.
Funding issues
Responding and adapting to the challenges of insecure funding and contracts and achieving stable, secure and adequate funding was a major challenge for many providers. In the context of historic underfunding of VSS services and a lack of ring-fence protection of SV budgets, VSS services were also grappling with the challenges generated by short-term funding streams from charitable trusts and commissioner grants (and, in a minority of cases, commissioned contracts). This created a high degree of precariousness about the longevity of services, which, in turn, affected staff morale and retention ‘We all build our services like Lego, so when that project goes you unbolt it and, with that, the learning, the staff, the expertise, all goes with it.’ (Practitioner 11).
In order to secure funding, voluntary sector leaders reported spending significant time writing bids and engaging with the ‘politics’ of funding calls. Senior practitioners raised concerns about how much of their role now centred on funding processes and fulfilling governance and monitoring requirements: a process Participant 9 described as a ‘never-ending hamster wheel’. In small organisations, this was seen as an additional pressure on already stretched staff teams and a poor use of senior staff’ time, curbing their ‘space for creativity’ (Practitioner 4) and ability to ‘think strategically around growth and development’ (Practitioner 9). A sense of feeling stretched and needing to make careful, sometimes, difficult decisions about competing priorities was common.
To minimise the insecurity created by relying on one or two main funders, many VSS services had diversified their funding streams and were now working with a range of charitable funders and commissioning bodies. This approach was viewed as a positive step towards retaining an independent, critical voice. However, it could also create additional pressures given the time and resource needed to attract and retain such a varied portfolio of funding streams. Several practitioners also emphasised the importance of specialist services guarding against ‘mission creep’. They warned that in a bid to diversify, expand and meet the expectations of contracts, VSS services could become stretched too thin and organisations’ reputations as specialist providers could be compromised.
Frustration was also expressed at the ending of ‘successful’ services (services that had met or exceeded their objectives and received positive feedback) and questions were raised about why there was not greater funding available to maintain VSS services that had a proven, positive track record. Practitioners also reported that services could be discontinued at short notice, which compromised continuity of support, sometimes for particularly vulnerable victim-survivor groups. This could negatively affect an organisation’s relationship with and reputation within some communities. Some VSS services had also stepped in financially to help wind down (and, if possible, continue) services when funding was stopped. This represented an additional cost to the organisation and meant that some services were being run at a financial loss.
For many practitioners, charities, trusts and foundations provided vital support that helped to ‘hold up’ VSS services, particularly during times of transition and upheaval. Although charitable funds came with reporting and monitoring requirements, such funding was seen to afford VSS services a greater degree of autonomy in the day-to-day running of services compared with commissioned contracts. In turn, charitable funding was associated with less pronounced power dynamics between funders and providers:
… their [charitable funder’s] overwhelming agenda all of the time was ‘what do you need to succeed and what do you need us to do next?’ But at the same time, you were under no illusion that you were accountable …
Charitable funding could also be used for services that might be considered ‘soft’ or ‘add on’ by public sector bodies, but which are essential to responding holistically to victim-survivors. For example, music groups, yoga, sound therapy and massage. Charities were also a major source of funding for work with victim-survivors’ friends and family members which, in most areas, was not routinely commissioned. In another area of comparison, there were examples of some charitable funders now promoting longer-term therapeutic interventions, which seemingly went against the grain of mainstream funding and commissioning practices:
She [charity representative] said ‘I’m fed up with seeing applications where it’s six to eight sessions. How can you do anything in six to eight sessions?’ and I was like ‘Oh my goodness. Are you stuck in the nineteen seventies or something?’ … that’s great.
Charities were also a valuable source of funding for VSS services’ ‘core’ infrastructure costs (e.g. employee pension and sickness costs, Human Resources and finance support, building maintenance/rent). This type of investment helped VSS services to grow and strategically plan. Despite these attributes, it was evident that charitable funding was varied and could generate the same instabilities regarding short-termism, as could commissioned contracts and short-term local and national government grants. For example, some charitable funding was seen to focus too much on innovative and ‘trendy’ topics, rather than maintaining good services and investing in specialist services’ infrastructure. In addition, certain charities and foundations could only fund one or two projects per organisation at any one time, or only those services who met certain financial thresholds, impacting their reach and ability to sustain VSS who had limited or inconsistent financial support from state bodies.
Key messages from work package 1
- The specialist nature of VSS services is highly valued by victim-survivors. In the voluntary sector, specialism relates to the knowledge and expertise of staff and the historic role many organisations have played in shaping responses and understandings of SV. Also, VSS services offer a dedicated, protected environment for victim-survivors where the shame and stigma of SV is understood and challenged.
- Challenges arise from working with ‘complex’ clients in a pressurised environment (e.g. high caseloads, rising demand, higher client need). Demands on staff within VSS services also centred on the challenges of competing for funding and contracts and the insecurities generated by short-term and innovation-focused funding. Practitioners were reported to be leaving VSS services, with an attendant loss of specialism and expertise from the sector.
- (Most) statutory services were seen to work in a different way with victim-survivors than those in the voluntary sector. Victim-survivors were seen to benefit from (and prefer) the independent and needs-led approach of the voluntary sector. However, good relationships existed between many statutory and voluntary sector services and there were examples of innovation and close partnership working.
- Over the past 10 years, statutory and voluntary sector services have faced increased demand for their services at time of widespread reductions and changes in funding streams. This has led to pressures on both sectors, and it was widely recognised that VSS organisations are now working with more ‘complex’ clients who in the past would have received statutory support. This transition has occurred without a commensurate realignment of funding.
- While longer-term investment is welcomed, VSS services expressed concern that the move towards joint-funded, large contracts is likely to favour larger, often generic providers. This threatens the survival of smaller, bespoke VSS services who provide valued support to victim-survivors. Developing partnership or consortia arrangements between VSS services can help services to share their resources and expertise. In turn, this can help them to compete alongside larger providers for bigger (often longer-term) contracts. This was the case for some of the practitioners we interviewed.
- In some areas, short-term and/or innovation-focused funding resulted in ‘good’, established VSS services struggling to survive. The associated precariousness negatively affects staff morale and retention and can undermine the sector leader’s ability to work in a strategic and creative way. Uncertainties about how VSS services are delivered can also undermine victim-survivors’ trust and the quality of support they receive.