One of the most arresting moments of lockdown was when Martin Houghton-Brown, chief executive of St John Ambulance, sat in front of MPs (virtually). It was March, and his charity was playing a central role in responding to the Covid-19 crisis, but he was warning that his charity could run out of money by August.
It’s now September and Houghton-Brown says he would not have wanted to be doing any other job in the sector. That's despite the crisis forcing a lot of tough decisions, and fundamentally changing the environment his charity, and the wider sector, operates in.
There are still challenges ahead. He, like many other charity leaders, is a facing significant financial deficit, and needs to reimagine what the charity's workplace and volunteer experience look like. But there is optimism, and excitement too, with opportunities to broaden St John's offer and build more resilient communities.
Income stream ‘dried up instantly’ as the charity stepped up
St John had an income of nearly £100m in the year to December 2018, with its largest income streams coming from delivering first aid training in workplaces and providing first aid at public events such as football matches. These “dried up instantly” in March.
“We were instantly plunged into a £1.6m a week loss,” he says. “At the same time, we walked into the NHS and said ‘what do you need us to do?’”
With high demand for ambulances and more NHS staff off sick or isolating, St John's was able to offer support in responding to 999 calls.
“We were able to deploy ambulances out across the nation.”
The charity also retrained its event first aiders to support the NHS in Covid care, taking them through a 40-hour training module and deploying them into hospitals.
By September these two pieces of activity had delivered 200,000 hours of patient-facing care since the pandemic began.
“I am hugely proud of all of those people, in particular those who have only ever provided first aid to smelly marathon feet, who were in a hospital in PPE working with Covid patients,” he says.
Often what volunteers brought to the table was the ability to spend time with a patient, enabling NHS staff to focus on clinical work.
In one example, a volunteer sat with an elderly patient whose family were unable to be at the hospital and quietly sang as she passed away.
“The difference, I think, was the ability to bring humanity to this crisis.”
‘The only measure of success is the state of the charity in 2022’
Shortly before the crisis set in, St John had switched from its normal structure to a “strategic command structure”, led by the deputy chief executive, Richard Lee.
“Normal structures weren’t going to work because you really need to get things done very quickly,” Houghton-Brown explains.
He says Lee describes the new set-up as offering “clarity and co-ordination”. It meant that “people knew what they needed to do and by when”.
Meanwhile Houghton-Brown’s job was to “get well out of the way and cheer him on”.
As chief executive, his priority was about the future sustainability of the charity. “The only measure of success here is the state of St John on 1 January 2022.”
He urgently needed to secure additional funding.
“From day one I started a vociferous campaign across government departments to gain a core funding grant,” he says. “My business case was simple: we will stand up our volunteers for the nation, we’ll reskill them, we’ll redeploy them and we’ll ensure we’re there for you as long as this takes, but I need the core funding that I would have supplied through my social enterprises.”
Ultimately, he was successful and St John was one of the first charities to benefit when the chancellor, Rishi Sunak, announced support for the sector in April.
Representing the sector
However, he knew it was not just about his charity. Much of the sector was facing a financial catastrophe.
“I did feel very passionately that my public work needed to represent the whole sector,” he says.
Houghton-Brown is full of praise for the work that infrastructure leaders, such as Karl Wilding at NCVO, Paul Reddish at Volunteering Matters and Jane Ide from NAVCA, did to lobby government and support the sector through the crisis.
“If there were three people that I would lock into a bear hug it would be those three people, because I think they have done so much for the sector,” he says.
He also emphasises that support and collaboration from infrastructure bodies and other charities, like the British Red Cross, meant he never felt lonely.
St John was one of the first charities to announce a consultation on redundancies, and 255 roles were placed at risk of compulsory redundancy.
It’s not something any chief executive wants to do, but with the government’s furlough scheme coming to an end, Houghton-Brown says “it’s not morally right for me to pay for these people who are not going to be working, when these charitable funds need to be focused on the nation”.
Since then, that figure has been drastically reduced, with the charity now expecting to make fewer than 30 compulsory redundancies.
This has come about through retraining some staff as ambulance crew, in order that they can take the place of volunteers who need to return to their day jobs after serving while on furlough. Others have taken voluntary redundancy or found new jobs.
‘It is going to be continuously horrid’
However, Houghton-Brown emphasises that there are no quick fixes to the challenges facing the charity.
“We put ourselves in a position to recover, but it is going to be continuously horrid in lots of ways,” he says.
St John is projecting a £10m deficit this year and a £5m deficit the year after.
This is partly because a change in the way that people work means there will be less demand for its workplace first aid training, and partly because ongoing social distancing means public events are unlikely to return to pre-Covid levels for some time.
“I have got to repay that debt,” he says. And this has led to the decision to sell 117 of the charity's buildings. “But we can’t rush that, so we are going to take our time to repay, using a combination of flexible resources from the bank and selling some of our equities.”
‘This has got to drive us closer together’
However, the buildings are already closed, so Houghton-Brown has been exploring other options for places his charity can use.
“I have already had great conversations with Matt Hyde at the Scouts and Denise Hatton from YMCA,” he reveals.
“If anything, this crisis has to drive us closer together as a sector,” he says. “Of course we will always have an element of competition for fundraising and some elements of social enterprise, but we’re one not-for-profit sector with one mission to make our nation healthy and whole, and equal and just.”
Digital transformation is key
Houghton-Brown, like many, expects many new, more flexible ways of working to remain.
He says that during lockdown, St John created virtual units for new volunteers.
“A big cohort of airline crew have become volunteers, and they are mostly in virtual units,” he explains. They meet when they’re out on duty or doing training, but have their weekly meeting online and many are happy with that.
“I’m going to be investing heavily in making St John more digital,” he adds. This means making it easier for commercial partners to engage, improving the customer journey, improving digital tools for volunteers and improving digital fundraising.
Digital is not the solution to everything though, and he is acutely aware that a lack of social interaction has been particularly hard for younger people.
Historically, fundraising has been a relatively small part of St John’s income mix. In 2018, £15.8m was generated by donations and legacies.
But Houghton-Brown has been trying to change that. “It seems surprising that this most trusted and loved of charity brands doesn’t capitalise on that with public support.”
During the crisis, the charity “ratcheted up fundraising”. It benefited from some free television advertising space and used volunteers in campaign films, leading to impressive results.
“Actually, we’re beating budget on fundraising by 20%. That is almost entirely from a huge public response and some really generous donations from corporates.”
Broadening the volunteering roles
Over the last few months, the charity's volunteer roles have diversified. For example, people have been driving doctors to and from appointments.
“We do like driving things,” Houghton-Brown says. “By us driving them they’ve been able to change their PPE, write their notes and get to the next patient more quickly.”
This widening of the volunteer roles on offer is something he expects to continue. He envisages something like a “community clinical support role”, where a volunteer could visit an elderly person who had fallen and make an initial assessment about whether they needed to call an ambulance.
“If we can prevent people from going to hospital, that’s a brilliant thing. It safeguards the NHS, it safeguards that person from complexity and it makes communities more resilient.”
This has the support of existing volunteers who are “passionate about their communities”.
However, he emphasises that the charity knows its limits. “I don’t see us morphing into that longer-term chronic care” where other organisations are better placed.
‘Our relationship with the NHS has changed’
Houghton-Brown also wants to build on the relationship the charity has with the NHS. Volunteers have been part of the NHS for a long time, but until this year it has mostly been around welfare, not clinical support.
“We felt very welcomed and supported to do the work they wanted us to do,” he says.
He’s eager to get an NHS cadet programme off the ground – this was an ambition before Covid hit.
“We are an educator,” he says, explaining that he wants to “nurture people who want healthcare careers and give them exposure and experience that might help”.
He likens it to the £40m a year that the Ministry of Defence invests in cadet schemes in order to create a pipeline into paid roles.
NHS England has already agreed to invest £3m “to take young people, in particular from communities facing disadvantage, and to give them access to the NHS”.
Houghton-Brown’s aim is to double the number of young people the charity works with. One of his plans for this year had been to “develop a programme very specifically for young people affected by violence”, in order to build on their skills and capabilities.
“Isn’t the heartbeat of every young person who is a joyrider really just an ambulance driver, frustrated?”