Chris Macqueen is the Associate Director of Strategy and Planning at the Stroke Association.
In the third episode of ‘Knowing Not for profits’, Chris joins Sustainability and Impact Lead and host, Sam Maguire, to reflect on the challenges and lessons learned in 2023 within the not-for-profit sector, particularly focusing on the Stroke Association’s experiences.
The discussion covers the impact of the COVID-19 pandemic, the cost of living crisis, and the ongoing challenges in the health and social care system.
Listen here or read on for an edited transcript.
Welcome to Knowing Not For Profits, a podcast series where Clarasys consultants will be talking through some of the most pressing issues from the not-for-profit world, bringing together thought leaders and industry experts to discuss their real-life experiences on these topics. Welcome to the latest episode of Knowing Not For Profit, Clarasys podcast that explores the charitable sector.
Sam Maguire: I’m Sam Maguire. I’m our sustainability and impact lead at Clarasys, and I’m really delighted to be joined by Chris Macqueen, associate director of strategy and planning at the Stroke Association. We’re going to be talking today about 2024 and what that might look like for not-for-profits. Chris, great to see you.
Do you want to tell us a little bit about your role at the Stroke Association and what the organisation’s trying to achieve?
Chris Macqueen: Sure. Thanks, Sam, and thanks for having me.
The Stroke Association is a UK charity. We’re concerned about people who have had a stroke, and our purpose really is to make sure that every stroke survivor gets the support and care that they need because we really believe that recovery is possible after stroke and we want to help stroke survivors move from just surviving a stroke to finding their way back to life and achieving as much recovery as they can. And so what we do to support that is we provide different kinds of support services. Our frontline staff visit people in their homes when they return from hospital. We have a helpline. We provide information in various ways. We also try to influence policy to make sure that stroke is the priority it needs to be in the health and social care system. We fund research into new treatments and new ways to help people recover, and we raise money to support the work that we’re doing.
My role really is to make sure we’re really clear about our purpose as an organisation and that we’ve got clear outcomes that we’re aiming for and that we’re creating the kind of conditions where people are really empowered to overcome the problems that are holding us back and preventing those outcomes. Particularly in a very complex world in which we operate, it’s really important to be trying things rather than just sort of trying to predict what would happen. We need to test and learn, so it’s trying to create the kind of environment where we’re constantly trying new things and then putting our efforts behind what we find works.
Sam Maguire: Amazing. It’s such a fabulous organisation, the Stroke Association and your acknowledgement there about the importance of testing and learning actually leads me on really nicely to my first question. How would you reflect on 2023, both for yourselves within the Stroke Association, but also in the charity sector, what are the lessons that you would take into 2024 from your experiments, from the things that you’ve tried?
Recap of 2023
Turbulent year
Chris Macqueen: Yeah, and I think I would characterise 2023 as a pretty turbulent year, you know, COVID seems some time ago, but we’re still sort of, in many respects, trying to recover back what was lost through COVID, this massive shock and disruption and in the world of stroke, many of the indicators we use to tell us how well people are being treated and supported in recovery, many of those took a real hit as a result of the pandemic. And in a sense, we’re still trying to recover what was lost.
I think another hugely important characteristic of 2023 has been the cost of living crisis, and that’s been squeezing both the income we can raise and the costs of providing the services that we provide. And I think now the evidence is that the cost of living crisis is both longer and deeper than the pandemic was in terms of its impact on charities and their sustainability.
The road back to post the cost of living crisis is still quite a long way off. It’s going to be a slow road back. And I think that’s affecting many charities in the sector, many of the smaller ones, we’re seeing higher rates of charity closure, often kind of unseen perhaps, but even among some of the bigger ones, you know, got charities like Oxfam and the threat and strike action sort of unprecedented in their history, so it’s really affecting the sector quite profoundly.
Challenges in the health system
Chris Macqueen: And then for us as a charity, we’re really strongly tied to the health and social care system. And I don’t think there’s probably been as turbulent a year for the health system other than the pandemic itself. There’ve been all kinds of headlines in 2023, reports of a fall in public satisfaction with health and social care, increases in ambulance waiting times, elective surgery, and all those sorts of things. Levels of excess deaths – that’s front page news in today’s papers is the number of deaths that are taking place from preventable conditions because the system is under such pressure, workload pressure, high vacancy rates, staff surveys showing increasing sickness of health and care staff due to stress, many parts of the system are still trying to absorb budget cuts that are taking a lot of energy and the list goes on. So, you know, it’s been a really challenging time for the health and care system. And, and that of course affects those charities that work in partnership with the health system and are trying to advocate and influence for better treatment and care.
Probably the last sort of feature of 2023, I would mention would be the cost of living is further exacerbating inequalities in the country where, you know, where you live has a profound impact on your needs and the likelihood that you will suffer poor health and the kind of treatment you get when you do. So as a charity, that also makes it challenging in this sort of postcode lottery of where do we put our effort when there’s such variation in what people are receiving.
Lessons learned
Chris Macqueen: In terms of lessons learned, I think we’ve really learned the importance of a diverse range of income sources, where in something like the cost of living crisis, some of our income sources are really challenged, really under pressure, whereas others are relatively untouched. So that’s been really important for us. And I think it’s confirmed for us the need to try to achieve even better balance between the different sources of income, be they sort of from legacies or public sector grants and contracts, grants from trusts, and also the sort of fundraising with individual donors.
I think another lesson for us is just re-emphasising the importance of agility and responsiveness. I think like many organisations, during the pandemic, we surprised ourselves with how quickly we were able to move all of our services online, and we wanted to retain that kind of agility we’ve managed to demonstrate, but probably like many, we’ve reverted back to the old, more sort of bureaucratic ways of operating.But I think the ongoing turbulence in the world in which we are working has reinforced the importance of being agile, of being able to rapidly understand the kind of problems that are emerging, test some solutions, and then back the ones that seem most promising and trying to deliver those changes at pace.
I think another lesson has been the importance of flexible working. We can’t compete with the private sector on the salaries we offer people, but we can compete with the flexibility of working arrangements and the other kinds of benefits around that. We’re a fully remote working organisation. And a lot of our people appreciate that. They can organise their home life and work life in a much more flexible way. So that’s been important in being able to attract and retain staff during very difficult financial times.
I think the final lesson I would say has been the importance of working positively in partnership with others. The crisis facing the health system is so acute that for a charity like ours, just to be critical and say things should be better is not very helpful. We need to be building relationships with decision-makers in the health and care system, understanding the challenges they’re facing from their perspective and what they’re trying to achieve and identifying those things that we can support them with and working collectively and bringing people together across the kind of private, public and third sectors to work together on trying to find solutions within the constraints that sort of currently exist.
Sam Maguire: Chris, thanks so much for sharing that. There are a couple of points that I just find super interesting. The agility point in particular. I think most organisations now are recognising that the volatility of COVID, of Brexit, of the cost of living crisis isn’t necessarily going to go away. It’s more and more volatile. Crises really help galvanize people around them. They want to be more intentional and get ahead of those processes and be able to manage their way through them rather than have them frost onto them. That agility point, I think it’s really interesting.
And then the second one in terms of how you guys are looking to contribute to health system change and be part of it is really interesting. I think we can see that if it is a labour government they’re calling for reform rather than just mass spend. So I think being part of that system change is going to be really important rather than again, having it done to you and not being part of it I think it’s going to be really critical.
So that was obviously a look back on the lessons you take forward. If we were here next year doing another podcast, what do you think would be the major things that you think will have changed for the sector and for Stroke Association?
Looking forward to 2024
Predictions of the landscape
Chris Macqueen: I’m certain there will have been some big changes, but such is the kind of uncertainty that it’s quite difficult to predict what some of them might be.
I mean, political, obviously, by this time next year, we may well have had a general election. If not, one will probably have been called. And so there may be some new political thinking and new relationships, new opportunities to partner and influence.
On the economic front, as I said, I think it’s probably a long haul to get through these high-interest rates, high inflation, high cost of living situations. So much as we would love things to be improving, I suspect those pressures will still be there and global instability and the opportunity that that might have an adverse impact on things, you know, things still looking really precarious in Ukraine and elsewhere. So I think it will continue to be a year of uncertainty and turbulence. So your point, I think about being agile is really important.
I think one change we can probably be more certain of is, we’re seeing this rapid development of AI capabilities and applications. I don’t know how other charities compare with us, but we’ve sort of been dabbling with AI, and I would expect by this time next year, more third-sector organisations will be making more substantive use of AI in their operations. And I think to do that, they’ll have to understand how do they really want to use it? What are the important principles that will guide where they do and don’t use these emerging capabilities and also how they ensure the safety and put the right safeguards in place. Just because you can with AI doesn’t necessarily mean you should. And I think if you are a strongly kind of purpose-led organisation as charities are, they may not apply AI in quite the same way as a very commercial organisation. But nevertheless, there are huge opportunities for cost saving, for improving the quality of data analysis for relegating unproductive processes and semi-automating them and focusing more on the kind of human contact that are often is what charities offer so well. So I think that will be a, I’d say a much more substantive use of AI.
Generational shifts
Chris Macqueen: I think the third thing I would say is it’s a gradual change year by year, but each year, the number of Generation Z millennials in our staff, volunteers, supporters is sort of gradually increasing. The number of baby boomers and Gen X decreasing. And with that sort of coming through of the younger generations, are differences in how they like to give and support charities, differences in how they use social media, differences in their expectations about technology. And so I think charities will need to be responsive to that ongoing shift in order to avoid sort of being left behind or failing to sort of match the expectations of their audiences.
Sam Maguire: That’s really interesting because you talked to two areas of innovation there. So AI, but also then potentially use of social media to, I guess, connect with the TikTok generation. Are there any other innovations that you’re seeing within the not-for-profit sector that you think are quite exciting?
Innovations in the Not-for-profit sector
Chris Macqueen: Probably some of us have been a little slower to embrace the kind of, you might call them customer versus customer-centric, customer experience-led use of technology and I think in the private sector organisations that we recognise as being very good at providing a good customer experience are using technology and data and iterating that to keep improving on the way that they present themselves. The things they’re offering to customers are sort of continually sort of getting better and better. This is something we aspire to do much better. We recognise we’re needing to develop capabilities to be able to rapidly iterate what we offer, how we present ourselves through our website and other channels, using feedback data to constantly improve the products and services that we’re offering both to supporters and to beneficiaries. So I think it’s innovative for the third sector, I suspect, but following the lead of private sector and the best sort of social enterprises out there.
Sam Maguire: And Chris, for you guys, who are your customers? When you talk about customer experience for the Stroke Association.
Chris Macqueen: We have a range of different customer groups. Our primary focus is onto people who’ve experienced a stroke, stroke survivors and their immediate families and the sort of support we’re providing. But many people who’ve had a stroke, they want to give something back, they want to volunteer for us, or they want to be involved in supporting us in some way.
Another customer group is our supporter base. The people who give money or time or raise their voice on our behalf.
We also have customers within the health and social care system. We deliver services to commissioners and we partner and work with health professionals in the system. And then we have a research community who we support financially and we’re seeking to build up a sort of community of stroke researchers, academics who will lead the way in the future in generating new treatments for stroke.
So these customer groups all have different needs and wants, and it’s a constant process of wanting to understand them better, understand their needs better. Be better at adapting what we do to meet those needs, be better at learning what’s working and continuously improving.
Sam Maguire: I think that’s really important to reach your purpose or to meet your purpose is to get that customer experience bang on. Definitely that resonates.
Last question I have for you, Chris, we’ve obviously talked a lot about the reality, but if we put our heads in magic Christmas mode, and if we thought about three magic wishes that you might have for 2024, what would they be?
Three Magic Wishes for 2024
Chris Macqueen: They’re quite big, but Hey, if you get a choice, you go big.
Sam Maguire: Got to go big.
Recognition of third-sector value
Chris Macqueen: I think for the third sector, I’d love to see the value of third sector organisations being more formally recognised, particularly by the public sector so that the incredibly important work that third sector organisations do in communities to support people in supporting people’s wellbeing individually and socially in addressing causes and concerns that where the state can only do so much. I’d love to see a more positive relationship between the public sector and the third sector, a willingness to engage more readily.
There’s a problem right now in that the public sector does fund a lot of charitable work, but the value of those contracts is eroding in real terms year by year, and more and more charities are finding they’re having to subsidise the services to a greater extent, and many are very much on the brink of not being able to afford to do that. So that would be one wish, just recognising the strategic value of charities and making sure that they’re funded adequately to do this critical work in partnership with the public sector.
Long-term thinking in the health system
I think the second wish, equally big, would be around the health system. And at the moment, it staggers from one crisis to the next. And all the decisions are very short-term trying to fight the fires. And we have a rapidly emerging challenge of an ageing population that is living with more chronic health conditions and the system as it currently stands needs to be focusing much more on how it’s going to cope with that. So we need to move from short-term firefighting to building and putting in place the kind of system that will be able to meet the rapidly increasing needs of the futures where we have to prevent people falling into ill health, rather than have this huge crisis of how to treat them when they do. So that would be long-term thinking and the investment in the health service.
Breakthrough in stroke treatment
And third one very selfishly would be a breakthrough in stroke treatment or care that would see many more people not suffering the kind of disabilities that stroke causes and which can be so devastating. So some kind of breakthrough in how we can treat people that. Dramatically reduces that kind of disability.
Sam Maguire: Three great wishes there, Chris. Unsurprising as a strategist that you picked some long-term thinking and I think we can all get behind that desire to see a breakthrough in stroke treatment.
Conclusion
Chris, thank you so much for joining me today and talking us through your thoughts on the not-for-profit sector. If people want to hear more about Stroke Association, are there particular places you’d like them to go to?
Chris Macqueen: Yes, if you go to our website, you’ll find lots of information there.
Sam Maguire: Fantastic. Thanks again, Chris.
Chris Macqueen: You’re welcome.
Thank you for listening to Knowing Not for Profits. We hope you enjoyed it and look forward to welcoming you back on our next episode. If you have a topic that you would like covered on the show or want more information on the topics discussed, please drop us an email at podcast@clarasys.com. We’d love to hear from you.
