Written Evidence by the British Heart Foundation to the Inquiry into the Funding of Voluntary Sector Organisations in Wales

Thank you for this opportunity to respond to the above Inquiry. I am writing to you to:

draw to your attention some examples of the range of ways in which the British Heart Foundation contributes to the support of local voluntary organisations and infrastructure in Wales;
contribute to your thinking from the perspective of a major national organisation which is both a funder and supporter of local voluntary organisations and other local infrastructure, and a fundraising organisation itself;
highlight some of the factors affecting the funding and provision of emergency life support for people experiencing heart attack in Wales;
highlight some of the difficulties we have encountered when attempting to contract to provide services in Wales.

1.0 Background to the BHF

1.1 The British Heart Foundation was founded in 1961 and is one of the UK’s top ten fundraising charities. The aim of the British Heart Foundation is to play a leading role in the fight against disease of the heart and circulation so that it is no longer a major cause of disability and premature death.

1.2 Our work was initially in the area of support for medical research and developing academics in the field of cardiology. Since then, we have also developed programmes of work in patient care, action research in community settings, and public education and disease prevention.

1.3 In Wales, and of course throughout the UK, the BHF works closely with governments, NHS, health professional and voluntary sector stakeholders to influence policy and service delivery. At the same time, we regularly run high profile national public health and fundraising campaigns and events which engage the interest of all sections of the community.

Heart disease in Wales - the facts

Heart and circulatory disease is Wales’ biggest killer, and is responsible for over 12,000 deaths a year
Since 1994 the number of people dying from Coronary heart Disease (CHD) in Wales has fallen but this means that more people than ever before are living with heart disease and need specialist care
Coronary Heart Disease (CHD causes over 6000 deaths a year in Wales and is the most common cause of premature deaths in Wales
People in the most deprived Welsh communities are twice as likely to die from CHD as those in the most affluent areas.

2.0 BHF funding of local VOs

2.1 To meet our organisational aim, the BHF provides funding to small voluntary sector organisations in Wales, including:

Heart Support Groups

There are currently 31 BHF affiliated heart support groups across Wales. These groups can provide a variety of activities and support to anyone affected by heart disease. The groups are set up by patients for patients and as a result they vary greatly.

Some are large organisations with regular exercise sessions, walking groups, newsletters, social outing and visiting lecturers, whilst others are smaller and provide monthly meetings and a friendly atmosphere.

If someone is thinking about setting up a new heart support group we have a number of resources that can help them to get the group off the ground. Getting a group affiliated to the BHF is easy and completely free of charge. Affiliation comes with a number of advantages including access to a £100 start-up grant, free public liability insurance and a regular BHF Network Newsletter.

Heartstart UK Schemes

Heartstart UK is an initiative co-ordinated by the BHF to teach members of the public what to do in a life-threatening emergency: simple skills that can save lives. The most important factor determining survival after a cardiac arrest is the time from collapse of the casualty to defibrillation. Performing Cardio-Pulmonary Resuscitation (CPR) buys time and more than doubles the chances of survival. Through Heartstart UK the BHF aims to make training more widely available.

Heartstart UK schemes are community groups that provide free ELS training for the public. The initiative works in partnership with local organisations to establish local community schemes. Many of these schemes run Heartstart UK courses that are open to the public. Others teach specific groups like employees and heart patients. The course lasts for two hours and provides very practical 'hands-on’ learning.

Young people of ten years and over can attend a Heartstart UK course at their school. However, some ELS skills like making a 999 call can be learned by much younger children. Heartstart UK schools provide ELS training for pupils, usually as part of their curriculum. The course can be delivered in two ways: as a stand alone course for children of ten and over, and as a staged programme starting with children as young as four or five years of age.

We currently have 225 active affiliated schemes in Wales teaching adults and pupils what to do in an emergency.

Resuscitation Equipment for members of the public

We provide life-saving cardiac equipment for use in hospitals and in the community, including automated external defibrillators (AEDs) which are used by First Responders - members of the public who have been trained to use fully qualified life-savers based throughout the local community. To date, we have made 150 defibrillator Awards for First Responders in Wales, totalling £747,331.

Hearty Voices training

Hearty Voices is a free one day training programme for heart patients or carers in Wales that can help develop and skills needed to represent the voice of heart patients or carers. To date we have trained nearly 100 people in Wales to get involved, both locally and nationally, in committees, groups, projects and initiatives that will enable them to influence the health service.

Help a Heart Grants

We make grants of up to £1,500 available to help fund community heart health projects that make a real difference to people living with a heart condition. We look for innovative ideas that will make people more informed about heart health, eg, projects that will help people to live a healthier lifestyle, ideas that will help relieve some of the stress and anxiety experienced by people with living with a heart condition, etc. Projects must be patient led. The more evidence of patient involvement and need an applicant can provide, the stronger the application will be.

3.0 BHF funding of other local infrastructure

3.1 Thanks to the tenacity and enthusiasm of our staff, supporters and volunteers in Wales, we have recently been able to contribute:

£1.2 million for vital research projects at Cardiff University,
Over £1 million spent on resuscitation equipment
£140,155 spent on diagnostic equipment for GP surgeries and hospitals
£85,000] for two Community Defibrillation Officers within the Welsh Ambulance Services Trust. £40,000 awarded in 2003 till 2005 and £45,000 awarded in 2006 till 2007
£167,460 for three Trainee Echo Technicians in Wales in 2005 till 2007
over £421,000 for 26 BHF Heart Nurse posts throughout Wales for 2007/2008 during

3.2 However, we could have made an even greater contribution if matched funding from government which had previously been promised had not been withdrawn. In 2005 the British Heart Foundation had earmarked funding of £300,000 (over 3 years) to establish a chair in Pre-hospital Care and Resuscitation Medicine at the University of Wales College of Medicine. This would have been the first chair of its kind and Cardiff was chosen in recognition of the proven track record of resuscitation expertise and research particularly from the group associated with the Pre Hospital Emergency Research Unit (PERU) - a well established collaborative initiative under the aegis of both the College and the Welsh Ambulance Service. It was anticipated that such a post would help to strengthen the infrastructure for community resuscitation - both in terms of emergency life training schemes and community first responder defibrillation.

3.3 There were however unfortunate delays in the recruitment of the chair and we were disappointed that then the promised continued funding from government was withdrawn. A strong infrastructure is vital for the support of BHF’s Heartstart UK initiative and also the growth and sustainability of investment in community defibrillation and the establishment of the chair was regarded by BHF as an exciting and innovative move to strengthen our objective in increasing survival from cardiac arrest.

3.4 It was also with both regret and concern for the future of community resuscitation in Wales that BHF has learnt that the Medical Director Welsh Ambulance Service’s post is to be discontinued from the end of this year. Dr Michael Colquhoun has worked closely with BHF over the past 20 years and has been an invaluable source of resuscitation expertise in helping to strategically direct the Foundation’s work in this key area. He has been responsible for the audit of automated external defibrillators (AEDs) to GPs and in the community, assisted on many key publications, fact sheets and booklets, served on our resuscitation related committees and been a key driver to our community resuscitation workstream. As an internationally renowned expert in resuscitation, he has been an asset to the BHF in supporting and shaping our community resuscitation initiatives across the UK over two decades. Both the National Defibrillator Programmes in England and Wales surpassed their objectives thanks to the integral role he played.

3.5 In recent years Dr Colquhoun has been Medical Adviser to the Welsh Ambulance Service and has been instrumental in helping secure funding from the Welsh government for public access defibrillators. A condition of BHF awards is that there is a supervising physician to oversee Heartstart UK training schemes and community AED schemes. He or she was expected to approve courses, trainers and assessors, to advise on the need for refresher courses, and to ensure high levels of competency in users. This role also oversees the effective audit of both training and personnel, ensuring that suitable 'critical incident debriefing’ is available and to ensure that reports on the use of AEDs and outcomes are notified to the BHF.

3.6 As Medical Director to the Welsh Ambulance Services Trust, Dr Colquhoun provides a vital service in overseeing the many affiliated Heartstart UK programmes across Wales and in providing the required clinical backing to 2000 community responders within their defibrillation schemes. We wish to make the point that the viability of effective local organisations which play a vital part in the fight against heart disease does not depend on the availability of direct funding alone. It is also dependent on the availability of the infrastructure which enables the maximum value of that investment to be realised.

4.0 Our experience of the contracting process: Big Lottery Fund Wales

4.1 Finally, in 2006, we submitted two expressions of interest to the Big Lottery Fund Wales to provide support and development to the Child’s Play and Way of Life Programmes respectively, under the Healthy Families initiative. BIG were concerned about the quality of bids they were likely to receive once these programmes opened, and were looking to contract with a key agency with expertise in nutrition and exercise to develop the capacity of voluntary sector organisations in Wales to apply for funding.

4.2 BIG particularly wanted the contracted organisation to develop: strategic links and a joined up approach to the health and well being of children and young people; models for projects; evaluation tools; links and interest amongst public health practitioners, voluntary groups and policy makers; grant applications from other VOs to BIG; support for projects once they were established; liaison with external evaluation of the programme commissioned by BIG, and peer review and dissemination of the findings.

4.3 This was a new departure for us, as we had not taken part in a tendering exercise for a contract of this nature before. We are pleased to report that our first attempt met with some measure of success, as both our expressions of interest were accepted and we were invited to submit full tenders. We withdrew our expression of interest in the Child’s Play Programme, in order to concentrate on the Way of Life Programme contract, as it was a closer fit with our core work. Unfortunately, we were not successful at the full tender stage, for a variety of reasons which we understand and accept. However, we would like to draw to the Committee’s attention a number of points arising from our experience which they may wish to consider as part of their inquiry:

the documentation which we were required to study and complete was very long, complex, confusing and time consuming. This was partly because BIG were required to comply with OJEU requirements. However, there appeared to have been no attempt to adapt the documentation to make it appropriate to the nature of the particular contract. Many of the questions were more appropriate to multi-million-pound construction projects than to the contract in question, and were therefore a waste of time and resources all round. In addition, the OJEU requirements seemed to have been inserted into a patchwork of several different internal BIG documents, with little apparent attempt to edit them into a coherent whole. This led to further repetition and inconsistency within the tender documentation;
we were not aware at the Invitation to Tender (ITT) stage that the information we had previously provided in the Pre-Qualification Questionnaire (PQQ) would be held in a different office from the full tender and not available to the full tender assessment panel. According to the feedback we received from BIG, this is normal procedure, but, as new entrants to the world of competitive tendering, we would have found it helpful to have been warned of this very clearly up front. Our response to the PQQ majored on our health promotion experience, and our response to the ITT cross-referred to it and stated that the two documents should be read in conjunction. They were not, with the result that we scored low on health promotion, an unfair reflection of our organisational capacity. This part of the process could easily have been stated in the tender documentation, so that we could have provided the information again, but it was not. There are very simple steps like this which could be taken to make the nuts and bolts of tendering processes more transparent and level the playing field with the private sector competitors, who are more used to it. Even better, the process could be streamlined so that organisations are not required to submit the same information twice;
according to our feedback from BIG, the assessment panel thought there was too much emphasis in our tender on the benefits of the contract to the BHF rather than to BIG - as though our private sector competitors were in it for entirely altruistic reasons. We suspect that this mistaken impression may be a result of a cultural difference between ourselves and a more technically-focused assessment panel. We were offering BIG the opportunity to team up with us at a key stage in our development in the health promotion field (the launch of our Prevention and Care Strategy), with two high-profile years for the BHF coming up (our fiftieth anniversary in 2011 and the Olympic year in 2012) which would have provided a major boost to their programme and a high profile showcase for its results. We were disappointed that not only did the assessors seem not to have grasped the added value that teaming up with a high profile national charity would bring to the programme, but that (we got the impression) they actually seem to have marked us down for drawing this to their attention. There also did not seem to be any acknowledgement of the added value for money in terms of existing materials, etc we were proposing to provide on top of the contracted service, in line with our charitable objectives - objectives which competitors outside the voluntary sector do not possess. The Committee may therefore wish to consider whether current contracting requirements and culture adequately accommodate what the voluntary sector has to offer in comparison with private and public sector organisations.

4.4 We should emphasise that we found our contacts at BIG Wales very helpful and accessible throughout the process, and we fully accept the decision of the panel. We are also conscious that Big Wales were working to extremely tight deadlines.

4.5 However, if the BHF, one of the top ten fundraising charities in the UK, has difficulty entering the contracting arena, the Committee may wish to consider how much more this is likely to be the case for smaller charities.

Conclusion

I hope this is helpful. If you have any queries or would like any further information, please do not hesitate to contact me. I look forward to seeing the outcome of the Committee’s Inquiry.

Delyth Lloyd
Press & Public Affairs Manager/Rheolydd y Wasg a Materion Cyhoeddus