Lifeline: the fall out
One organisation that we can exempt from this form of criticism is Contact NI.
It has just issued a critique of the Public Health Agency’s planned changes to the Lifeline services which it brands as “unsafe and unfit for purpose” and driven by austerity.
In response the PHA categorically denies the claims made and has written to MLAs to say is “taking steps to deal with” a news outlet that published them without “any counterbalancing fact.” It states that the austerity charge is baseless as it is planning to spend the same amount - £3.5 million – on the new service as the old.
This is just the latest and most heated phase of a row that has simmered for at least two years about how best to run the crisis response service against the backdrop of the rising levels of suicide in Northern Ireland.
What makes it all the more remarkable is that Contact NI’s main activity, and therefore revenue stream, is operating the very same Lifeline service, which is shortly to be put back out to tender by the PHA. There must be serious doubts as to whether it would survive losing the contract.
This kind of public falling out between a public body and the deliverer of a service is unprecedented in Northern Ireland, especially given how high the stakes are. Many in the sector will be watching this unfold with more than a little interest.
The Concordat signed between the Executive and charities in 2011 specifically asserts the independence of the sector. But when suppliers have serious differences with public bodies about how services should be delivered does this signal an irretrievable breakdown of the relationship? What does it do for the working arrangements between commissioner and supplier? Is independent thought a realistic aspiration in circumstances where one party is contracted to deliver for another on terms set out in a procurement process?
It is important to stress that the row has not had an impact on the service itself which continues to operate as normal as the row rages around it. The integrity, professionalism and operationa leffectiveness of the Contact NI staff who run it has never been questioned by any party. It is more that the Contact NI/PHA relationship has become like an unhappy marriage where the partners are still working together for the benefit of the kids.
Lifeline is a crisis telephone helpline which is backed by a “wraparound” counselling service. That is to say that those calling for help who need further assistance can be referred on to counsellors for support. Currently these counsellors are either employed or sub contracted by Contact NI.
Contact NI says there are plans to change the criteria for counselling from offering “immediate help for anyone at risk of suicide” to 'those at immediate risk of suicide'.
It describes this “unsafe, lacks credible evidence and is unfit for purpose.” It alleges it is part of an austerity agenda.
The PHA denies this. It says criteria for assessment will not change and that there are no plans to save money and that Contact NI is misrepresenting its position.
One matter which is not in dispute is that the new contract will be split. Lifeline will continue to function but counselling will be provided on a regional level. Contact NI describes this as “fragmenting” the service. The PHA claims it will enhance it.
There is no sign whatsoever that this will be the end of the matter. Indeed Contact NI has just issued a point -by-point response to the PHA’s letter to MLAs.
The dispute is embarrassing for the PHA, not least because Contact NI’s chief executive Fergus Cumiskey is a leading suicide prevention campaigner with a burgeoning international reputation. For Contact NI it has become an existential crisis.
Scope is not in a position to adjudicate between the PHA and Contact NI. That is a matter for the experts.
What is not in doubt however is that suicide rates in Northern Ireland have actually worsened in recent years.
In NI 318 people died by suicide in 2015, the last year for which suicide statistics are available and the highest to date. The NI death rate is 19 per 100,000, more than 20% worse than any UK region or the ROI.
In that context Contact NI has broadened the debate by calling for an independent evaluation of Lifeline and also a Hillsborough-style Expert Panel review of suicide deaths in Northern Ireland.
The PHA’s position is that Lifeline, a crisis service, is only one part of the efforts to prevent suicide which involved pretty much all parts of government as well as the PHA. It had a strategy in place, Protect Life, which has been evaluated and a new policy is being prepared by the Department of Health. This work, however, cannot be published until a new Minister is in place.
The instigation of a Hillsborough-style review is beyond the remit of the PHA, and an issue for an Executive.
The dispute has erupted at a time when there has been growing disquiet that the increasing dependence of charities on government contracts has undermined their independence.
Two years ago the National Coalition for Independent Action disbanded stating: “We have failed in our other aspiration – to persuade mainstream voluntary services to speak out with others in pursuit of social justice and defend their autonomy as independent forces for change.”
A subsequent report by the Baring Trust concluded that there was a lack of meaningful consultation with the Sector by government and insufficient safeguards for the independence of charities.
Last year Ulster University academic Markus Ketola raised eyebrows when he carried out a piece of research designed to ask the following questions of Northern Ireland-based charities.
Is the community and voluntary sector truly independent or has it become a tool to implement government policy and if so does that matter?
Is it important that charities campaign for social change or is effective service delivery all that matters?
Are charities inhibited from campaigning for change because they fear repercussions from civil servants or politicians?
Does the current public procurement regime inhibit innovation amongst charities who are forced to work according to a pre-ordained script which may or may not deliver the desired outcomes?
Are many charities too fearful of losing contracts to propose alternative that might work better?
Ketola’s findings suggest that there is at least some cause for concern.
However it is hard to envisage that anyone in the independence camp see what is happening between the PHA and Contact NI as an example of the sort of healthy exchange of views that is required.
The tragedy of this case is that there are good people on both sides of the argument. Their commitment to running a first-class crisis intervention service is not open to question.
Furthermore there needs to be a thorough-going open and courageous debate about the prevalence of suicide in Northern Ireland and the responsibilities not just of the PHA and the Lifeline service but of broader society in helping to tackle it.
This is especially the case given the growing consensus amongst experts that all suicides are preventable to the moment of death. If that is the case then all those 318 deaths in 2015 were avoidable. We clearly need to learn more and to talk more about what is required to reduce this number, ideally to zero.
Given Cumiskey’s pre-eminence in suicide prevention circles it would seem a great waste for him not to be involved in informing and challenging policy into the future whatever the outcome of the tender process.
Perhaps the lasting lesson is that advocacy and service delivery are uneasy bed fellows. Combining them creates potential conflicts of interest and can poison supplier/commissioner relationships. An appropriate government response would be to fund both types of activity.
Public policy does need to be questioned and challenged and held to account especially on a matter as important as this. This can be frustrating, even downright irritating for public bodies. Yet there is always a need for an awkward squad especially in such difficult policy areas. Mr Cumiskey appears eminently qualified for that.
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