Context of work package 5
Chapters 3–5 presented the quantitative data from the survey and the qualitative data arising from the interviews and focus groups in WP1 and the deep-dive qualitative analysis of the case study analysis in WP3. The purpose of this chapter is to draw together the different strands into a cohesive whole in order to arrive at a comprehensive synthesis of findings. It is noteworthy here that the focus of this chapter is on the empirical findings, not the extensive largely autoethnographic work with co-researchers. This integral part of PROSPER is revisited in the next chapter.
Revisiting the key findings from the PROSPER study
A useful starting point to inform this integrative stage of the analysis and synthesis process is to revisit the findings presented so far in the report. Table 9 displays the findings from WPs 1–3 as presented at the end of each relevant chapter. These form the basis of the rest of this report.
Insights from each work package juxtaposed with the study objectives
An important part of the integration process is to consider how each of the WPs has responded to the PROSPER study objectives. We undertook a mapping exercise to create a matrix showing the relationship between the different WPs and the study objectives (Table 10). The red domains show a weaker contribution to addressing the objective on the same row and the green show the strongest. There are shades of orange and yellow that indicate a partial contribution. For example, for objective 1, which was concerned with capturing the experiences of victim-survivors, unsurprisingly, the victim-survivor interviews that took place in WP4 provided rich insights. Conversely, again, for example, the commissioner survey of WP1 and the commissioner interviews of WP3 contributed very little to the overall findings in relation to objective 3, which is concerned with service delivery. It was the victim-survivor and practitioner interviews of WP3 that helped most in responding to this particular objective. In terms of integration, the matrix is a useful tool to demonstrate patterns and degrees of how methods relate to objectives. Moreover, in relation to the PROSPER study, the green segments in every row demonstrate overall success in achieving each of the study objectives through the combined findings across the WPs.
| WP1 key findings | WP2 key findings | WP3 key findings |
|---|---|---|
| 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. | Huge variety of service scope, organisation, funding, delivery.Complex patchwork of services often working closely with each other to support victim-survivors. | There needs to be a greater recognition of the unique value of independent, VSS services in providing flexible and responsive support, using a victim-focused, trauma-informed approach and representing voices of victim-survivors. |
| 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). | Service configurations may reflect a legacy of historical funding and commissioning arrangements but evidence of effective, needs-led practice.Many VSS service providers offer support that no other services do, and often to under-represented groups, for example, sex workers. | For victim-survivors, there needs to be more effective promotion of VSS services for the benefit of enabling them to become aware of the services and make informed choices about engaging with them.There should be a genuine commitment to work with victim-survivors to co-produce services to avoid retraumatisation. |
| Demands 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 services work with a variety of commissioners, with varying satisfaction with these arrangements.Complex funding landscape: most services rely on multiple funders, but a dynamic and evolving picture. | Referral pathways between services must be clear and effective. |
| (Most) statutory services were seen to work in a different way with victim-survivors compared to those in the voluntary sector. Victim-survivors were seen to benefit from (and prefer) the independent and needs-led approach of the voluntary sector. | Providers competing for same funding, an inconsistent/unstable funding, clarity needed around funding context. | Partnerships appear to work well in terms of connecting the VSS services and statutory (e.g. NHS) services with each other, and with commissioners. Partnerships should offer a space to share knowledge and resources, dedicate time to think through ‘complex’ individual cases and to work collaboratively on strategic and financial issues. |
| Good relationships existed between many statutory and voluntary sector services and there were examples of innovation and close partnership working. | Substantial unmet need which restricts responsiveness to client need, waiting lists growing over time. | Partnerships should offer a layer of support, accountability and structure to existing ‘good’ working relationships and should raise the profile of SV across the area. However, relationships between services can break down when there is competition over funding provision. |
| 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. | Service users with complex trauma, restricted duration of support, worries about not meeting victim-survivors’ needs, in some areas a need to expand support for under-represented groups.Difficulties due to funding competition, problems with referral processes, good links support certain under-represented groups, enhanced working with NHS and statutory services. | Resources for supporting victim-survivors with ‘complex’ needs must be better understood and provided, to support partnership working.Long-term sustainable funding for the sector would reduce waiting lists and increase the speed of service access. It would also allow for longer-term support where needed. |
| 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. | Need for greater capacity and efficiency.High turnover, stressful, difficulties funding specialist team staff members. | Commissioning in ways that understands and favours specialist services is needed, for example by scoring weighting to recognise the importance to specialism and local knowledge, would support services to grow their provision in line with demand, and would ensure victim-survivors were accessing the most specialist support. |
| 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. | Need for more holistic support, increasing provision of wraparound projects that add value to core services. | |
| 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 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. |
Data integration and the PROSPER theoretical framework
Billis and Glennerster’s50 theory holds that the unique feature of voluntary sector services are:
- flatter organisational structures with less distance and distinction between senior or decision-making staff and those on the front line
- closeness to communities
- being mission-led and driven by core values and purpose.
As explained in Chapter 2, we revisited this theoretical framework frequently throughout the progress of the PROSPER study to ensure that our findings were grounded in the study’s theoretical underpinnings. We had intended from the outset that the three domains of the framework would form the basis for organising the findings at integration stage. Once we began the process of mapping the findings from WPs 1–3 to the framework, however, we discerned some limitations that necessitated an adaptation to meet the specific needs of the PROSPER study.
Adapting Billis and Glennerster’s theory to meet the needs of the PROSPER study
According to Bradbury-Jones et al.,73 there is a legitimacy in adapting a theoretical framework to meet the needs of a study because it avoids the unhelpful practice of ‘squeezing’ data into a framework where there is a poor fit. They caution though, that this needs to be undertaken carefully and transparently. We had selected Billis and Glennerster’s50 theory because it is concerned with the voluntary sector. To that end, its three broad domains were relevant and appropriate in shaping our findings. However, it was not developed specifically in the field of SV, nor was its focus on funding and commissioning of voluntary services. While the focus on SV was unproblematic, we encountered challenges in contextualising the PROSPER findings regarding funding and commissioning. As discussed in the relevant chapters, conceptually, our findings went beyond values, communities and organisations, to a broader commissioning context. This is understandable given the aim of the PROSPER study. However, rather than abandon our theory on the basis of its limitations, we chose to adapt it and add a broader, macro level that encompasses the commissioning level. We also pared back the language used by Billis and Glennerster to shorter statements, while retaining the essence of the theory. Data integration was thus achieved with reference to four theoretical domains:
- macro commissioning context
- organisational structures
- relationships and people
- values and principles.
The data integration process
Data integration is the process of bringing data together from different stands of a study to draw out new insights beyond those gained from separate quantitative and qualitative results.88,89 In the context of the PROSPER study, integration of data was led by the lead author and verified through a number of iterations with the rest of the team until consensus was achieved. The first part of the process involved a deductive approach.90 By this, we mean that we used the broad statements that were held within the data as the starting point and made sense of them with reference to the specific details of our theoretical framework. In practice, this involved taking the findings from each WP and mapping them onto the (adapted) theoretical framework, seeking the closet fit to either one of the four domains. Once this stage was complete, verification and agreement with the rest of team took place. This was a relatively simple communication using e-mail and no revisions were made as a result.
Integrated PROSPER findings
Table 11 shows the integrated findings from the three empirical WPs presented in accordance with the amended theoretical framework. While these are presented as four discrete areas, we emphasise their interconnection and the influences of one domain upon others. In the following, concluding chapter, we highlight this interconnectivity by presenting a diagrammatic representation of the overall PROSPER findings.
| Less relevant | Most relevant | Stage 1 | Stage 2 | WP4 | WP5 | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| WP1 | WP2 | WP3 | |||||||||||
| Practitioner/commissioner interviews | Commissioner survey | VSS survey | SARC survey | Survivor interviews | Practitioner interviews | Commissioner interviews | Co-research with survivors | Data integration | |||||
| Explore survivors’ experiences of accessing and using VSS services, identifying what needs are being met for which groups of survivors, and what encourages survivors to take up services | |||||||||||||
| Analyse the range, scope and funding of VSS services and how demand is managed | |||||||||||||
| Explore the usefulness of different approaches to service delivery (including peer support and delivery by volunteers) and different therapy models | |||||||||||||
| Explore how different principles underlying service provision influence service delivery, including feminist and trauma-informed principles of care | |||||||||||||
| Investigate referral patterns and pathways, and how VSS services fit with each other and link to the wider network of services for survivors | |||||||||||||
| Explore how arrangements for commissioning and funding services for survivors across health, local authorities and criminal justice have evolved over the last 3–5 years, and how they have impacted on VSS service provision | |||||||||||||
| Develop a taxonomy of the VSS services/service models being commissioned and provided | |||||||||||||
| Make recommendations for the commissioning and provision of VSS services at practice and policy levels, in order to strengthen overall service provision for survivors of SV | |||||||||||||
| Macro commissioning context |
| Complex (and precarious) funding landscapeService configurations may reflect a legacy of historical funding and commissioning arrangementsNational government and centralised funding policies not reflecting local needs and the reality of demandChallenges of competing for funding and contractsJoint-funded, large contracts favour larger, often generic, providers which potentially squeezes smaller services out of the ecosystem of supportFormal collaborations through consortia or joint-partnership arrangements are complex but well-received by commissioners (and practitioners, if done well)Short-term funding that rewards innovationThe commissioning agenda might act to move services away from being truly victim-survivor-led |
| Organisational structures |
| Increasing range of services providing support to victim-survivors through the commissioning processVoluntary sector specialist services ‘upskilling’ staff to provide support to victim-survivorsVoluntary sector specialist services working closely with each other to support victim-survivorsComplex patchwork of services often working closely with each other to support victim-survivorsPressurised environment (e.g. high caseloads, rising demand, higher client need)Working with complexity in clients’ livesPractitioners leaving VSS services, with an attendant loss of specialism and expertise from the sectorUnmet needs and under-represented groups vs. good links to support under-represented groups |
| Relationships and people |
| Good relationships do exist between many statutory and voluntary sector services with examples of innovation and close partnership workingMost services work with a variety of commissioners, with varying satisfaction with these arrangementsServices can be hard for victim-survivors to navigate and accessUncertainties about how short-term VSS provision is delivered can undermine victim-survivors’ trust and perceptions of the quality of support they receive |
| Values and principles |
| Voluntary sector specialist services are highly valued by victim-survivorsVoluntary sector specialist services offer a dedicated, protected environment for victim-survivors where the shame and stigma of SV are understood and challengedNeeds-led services are important, that focus on survivor empowermentFeminist and trauma-informed approaches are valued within the VSS sectorGender awareness is also important, within a broad framework that takes account of intersectionalityDetailed understanding of sexual abuse constitutes what it means to be a specialist SV service |