Strategy for Survival

Challenging times mean smaller organisations must embrace new ways of thinking, says Caroline Cole.

We operate in difficult financial times, and for charities delivering addiction services in England the landscape is particularly challenging. As interim CEO of an exemplary residential abstinence-based 12-step treatment centre, and observing similar charities closing while private ventures open up, I have been pondering the feasibility of our charity and designing plans for our survival in this difficult world.

There are two key questions. First, can we free ourselves from the fierce statutory commissioning environment in which we work, and on which we have for a long time been dependent, while remaining true to our altruistic vision and mission? And second, can we use learning from the profit-driven corporate world to inform our strategy?

I am primarily concerned with how rehabs that are charities rather than businesses can position ourselves and borrow from corporate strategy to support sustainability. Things are not getting easier – investment in abstinence-based treatment is not on the political agenda, and the stigma of addiction prevails so public understanding and support for our services is at best limited and at worst dismissive.

Broadway Lodge in Weston-super-Mare is the oldest 12-step addiction rehab in the UK, having been operating for 43 years. Throughout this time we have supported well over 13,000 people to rebuild their lives and we have a huge cohort of alumni, some with decades of recovery. As pioneers in the 1970s and 1980s we functioned as a consultancy for other 12-step treatment centres that followed this highly successful model – people who found recovery asked us how to do it, we told them and they set up more treatment centres.

In these early days there was sufficient statutory support for people to be treated without knowing who was paying, and these people were treated alongside people who were paying privately – duke or dustman, we mucked in together. Treatment then was based on a public service and charitable ethos rather than a profit-grabbing corporate ethos.

Since then, statutory funding for treatment has gone from abundance to austerity and a place of uncertainty and peril. In the 2000s drug money was ring-fenced for many political reasons, not least the emphasis on crime reduction and public health, and although it was sensibly targeted mainly at harm reduction services there remained a small niche that offered abstinence. Clients therefore still had some choice of the treatment modalities they were offered.

The change of government in 2010 brought hope that the new PM, a strong supporter of 12-step recovery, would occasion a revival of treatment centres by insisting on a more evenly balanced provision between harm reduction and abstinence-based recovery. Sadly, this aim never percolated through to commissioners and when ring-fencing was lifted and budgets reduced throughout 2014-15 and 2105-16, 12-step and other abstinence rehabs were the main casualties.

Add to this the focus on fewer but larger contracts to drive down costs and the sector has seen integrity give way to greed and the pursuit of profits, with small/medium charities squeezed twice – at commissioning level with the cuts in overall funding, and as a potential sub-contractor to larger organisations for whom it is easier to provide the service themselves and retain the revenue. In this model, clients lose choice.

Bargaining powers are limited for charities such as ours. Because of our position in the supply chain, our suppliers (of referrals) are also our customers and this creates a dual difficulty. We as providers are both buyers and sellers but we lose any buying advantage in our need to sell. Statutory services have to be delivered in accordance with the expectations of the commissioners and all contracts or spot purchases are a trade-off between what we, as experts, know to be effective, and what the commissioners require or allow us to provide.

So what options remain? Regarding statutory commissioning, I for one am not convinced that our long-term lobbying for change at high levels is effective. So, on the principle that if something is not working, instead of continuing to try harder let’s do something different.

What we have learnt with the response to the horror of Grenfell Tower is that grass roots movements are powerful. Governments cannot control them, and they often arise where governments have failed. If we stop wasting energy doing what doesn’t work, and concentrate on ‘doing it for ourselves’ by garnering support from the public and previous beneficiaries of our treatment, rather than the politicians, we may just be able to raise enough revenue to create a treatment and recovery system; one that actually works and is more attractive than the uninformed, misguided but dominant political narrative and broken, ineffectual system we have at present.

Harnessing alumni and family members as ambassadors and champions draws down potent support. A quick look on Facebook shows the huge cohort of fans of Broadway lodge who are eager to help and promote the rehab that gave them or their loved ones their lives back. By recognising this loyalty capital and monetising it through events and involvement, an authentic exchange of energy takes place that delivers outcomes from Broadway’s commitment to, and investment in, treatment and recovery.

Negotiating collaborations with other, similar, treatment providers in order to widen the referral net and then allotting the clients fairly and accurately according to their needs is a strategy that depends on a trusting relationship that has to be built between all players in the system. This takes time and risk, but the results are profound and provide a win for all participants. Thus we develop a network of collaboration, liaising and negotiating cost savings and identifying nascent markets and those with excess capacity that we can collaboratively penetrate and secure.

Instead of remaining dependent on statutory funding and dancing to someone else’s tune, Broadway Lodge – working in concert with other providers and collaborating on projects that identify synergies, share efficiencies and extend our thinking beyond the statutory realm – can deliver new and exciting strategies that foster success and enable everyone to shine.

When society improves, the people within it improve as well. Linking with like-minded providers who also trust this premise, and extending that trust to each other, provides a powerful, self-supporting system for treatment delivery that is independent of government. It involves sharing and transparency but the benefits are manifold. It is a game changer and one of the ways in which small and medium sized charities can survive and shine in this very challenging environment.

We can maintain presence and power in the treatment system, allowing us to develop a more extrovert personality and a stronger voice predicated on power harnessed through collaboration. This in turn means that clients have a wide choice and people with severe addiction be offered full abstinence-based, in-depth treatment that creates a platform for real recovery and a fulfilling life.

To return to the two questions I asked at the beginning: Can we free ourselves from the fierce statutory commissioning environment in which we presently work while remaining true to our altruistic vision and mission, and can we use learning from the profit-driven corporate world to inform our strategy going forward? The answer is a resounding YES.

Caroline Cole is interim CEO of Broadway Lodge