Work package 3: case study analysis

Context of work package 3

The case study phase was conducted across four areas in England. In these four areas, the interviews with victim-survivors, staff and funders were designed and conducted to investigate: what services exist; how victim-survivors find their way to and through different services; what is valued about these services; what gaps there are; and how well commissioners and funders work together.

The specific objectives for WP3 were to:

1. explore victim-survivors’ experiences of accessing and using VSS services, identifying what needs are being met for which groups of victim-survivors and what encourages victim-survivors to take up services
2. analyse the range, scope and funding of VSS services and how demand is managed
3. explore the usefulness of different approaches to service delivery (including peer support and delivery by volunteers) and different therapy models
4. explore how different principles underlying service provision influence service delivery, including feminist and trauma-informed principles of care
5. investigate referral patterns and pathways, and how VSS services fit with each other and link to the wider network of services for victim-survivors
6. explore how arrangements for commissioning and funding services for victim-survivors across health, local authorities and criminal justice have evolved over the last 3–5 years, and how they have impacted on VSS service provision.

In the absence of large-scale evidence about victim-survivors’ experiences of VSS services, the case study research phase placed victim-survivors’ views and experiences at its centre and analysed the degree to which provision met their expressed needs. It looked for gaps and overlaps in service provision; underserved subgroups in the population; the use of service rationing; the use of recognised service quality standards; the extent to which VSS services are a coherent part of an area’s service provision for victim-survivors, and to what degree VSS services also support victim-survivors in accessing other services (e.g. mental health, sexual health, substances misuse) in the statutory, voluntary and potentially private sector.

Methods

The case study WP involved interviews with victim-survivors, practitioners and commissioner/funders across four areas in England. This WP was designed to build on WPs 1 and 2.

Site and service selection

Within each case study site, the research attention was on all VSS service provision in that area (geographical boundary). Within these areas, there also existed services that provided some support to victim-survivors of SV (e.g. counselling services), but their work encompassed wider areas (e.g. mental health more broadly) and therefore, would not be considered SV 'specialists'. However, to create a full picture of each site, where permitted, we engage with those services and with relevant statutory provision (e.g. services within the NHS such as SARC).

Initially, selection of sites was to be driven by findings from the national surveys. However, due to COVID-related delays, these data were not available at the time of site selection. As an alternative method, the research team developed a list of 11 possible case study sites (with the intention of selecting 4) based on:

• WP1 interviews with 8 commissioners of specialist SV services, 13 practitioners based within VSS services and 2 individuals working in statutory SV organisations
• recommendations and conversations with senior members of specialist SV umbrella organisations who understand their member services and familiarised us with local funding/commissioning tensions, unique approaches to service delivery, etc.
• publicly available data from the Charity Commission (and financial information available to year end March 2020) and the websites of VSS services
• demographic data drawn from the 2011 Census (with estimated population projections used for some areas) and the 2019 Indices for Multiple Deprivation Index as organised by upper-tier local authorities.

When this information was gathered, decisions about site selection were discussed and advice sought from the study steering committee and the wider co-applicant team. Achieving diversity across the four sites was an important consideration. Ultimately, we selected our final four sites based on achieving maximum geographical variation across England (north/midlands/south); population density (urban/rural); demography (disadvantaged/affluent/mixed); and diversity (high/low black and ethnic minority populations). However, our principal criterion for site selection was to achieve variation in the sites’ VSS service models and their underpinning funding and commissioning arrangements.

Sites were defined geographically by city and/or county boundaries, or groups of neighbouring districts. It was not feasible for the sites to be of the same population size or area given the varied ways that services are configured, funded and commissioned. For example, the catchment areas for local authorities, CCGs and OPPCCs are rarely coterminous; similarly, VSS services may receive dedicated funding to work with victim-survivors in one area but seek to provide the same service to victim-survivors in another area, drawing on funding from charitable trusts or fundraising. It is also the case that certain areas have no VSS services and victim-survivors must cross city/county boundaries in order to access provision.

Within the case study sites, data were drawn from three primary sources:

1. documentary analysis
2. interviews with staff (e.g. those working in VSS services, commissioners/other funders, NHS/LA staff)
3. interviews with victim-survivors, drawing on techniques of narrative interviewing and the Critical Incident Technique.

Participant recruitment

Within each case study site, the key VSS services were identified and approached. Those services willing to participate were provided with a £500 honorarium to pay for staff time and as a token of gratitude for helping to facilitate the research process. Victim-survivor participants were alsocompensated for their time in the form of a voucher. In addition to being asked to participate in an interview, staff were asked to identify other potential practitioner and commissioner/funder participants within and across related organisations. Staff in the VSS services also supported the recruitment of victim-survivors. The research team worked with the services in each site to help ensure that the approach to recruitment and interviewing of victim-survivors was ethical and non-intrusive, with minimal selection bias. Victim-survivor participants were also compensated for their time in the form of a £20 voucher.

Criteria for inclusion and exclusion for the victim-survivor participant group:

Inclusion:

• victim-survivor of SV (self-defined; recent or non-recent)
• subjected to SV 6 months or more ago
• if accessed VSS services, done so within the last 5 years
• people aged 16 + years, or children aged 13–15 years
• able to provide consent to take part.

Exclusion:

• subjected to SV ˂ 6 months ago
• if accessed VSS services, done so more than 5 years ago
• children aged below 13 years
• children aged 13–15 years who do not meet Gillick competency
• any adult for whom the research team has concerns about their safety or well-being taking part
• adults who are unable to consent to take part.

Table 7 outlines the projected and actual figures for recruitment across all participant groups. As shown, the actual recruitment fell short of our intended numbers. Table 8 shows a detailed breakdown of participants across the case study sites, by way of demographic profile.

Prior to/the start of the interview

To support participants in their decision to engage in the interview, they were sent a participant information sheet which included contact details for the research team. Participants had an opportunity to review the material sent in advance and could ask questions prior to participation. Occasionally, the study team would speak with potential participants on the phone to discuss any questions or concerns they had before they participated in the interview.

If an individual agreed to participate, the researcher confirmed the date, time and location of the interview, as well as who would be conducting the interview. Most participants (N = 59) elected for the interview to take place virtually – mostly by Zoom or telephone. In-person interviews were conducted at the location of the VSS service. Around half of the victim-survivor interviews (N = 16) were conducted by both a researcher and a co-researcher.

Before the interview, all participants were also sent a copy of the consent form and demographic questionnaire. It was originally envisioned that participants might complete these within/at the time of the interview, but the process was amended to account for most interviews not occurring in person. We sent the consent form to participants prior to their interview and asked them to return it to us (where possible) before their scheduled interview. For those who were unable to return it, we took verbal consent at the beginning of their interview, and reconfirmed consent with those who had already returned it to ensure they were still providing informed consent to participate. All participants were encouraged to ask any questions they had about aspects of the study or consent/their participation. Participants were reassured that their involvement was completely optional and that they were able to withdraw their data up until a pre-defined time after the interview had been conducted. We took measures to ensure that participants’ information was secure, and we explained those measures to participants. Participants’ contact details were shared only with members of the research team who needed to be aware of them. Participants were made aware of how long their information and documents would be retained and participants were given identifying numbers/codes instead of using their names or any other identifiable information to assign to their data after transcription and anonymisation. All information was securely stored on University of Birmingham networks.

The interview

The interviews began with an opportunity for the interviewer(s) to explain the purpose and scope of the study, provide an overview of the interview process and allow for participants to ask any questions. Audio recording of the interview began after this introduction was complete and the participant was ready to begin.

Interviews followed participant-specific topic guides tailored to each participant group. For victim-survivor participants, the topic guide was designed to support them to recall their experiences of accessing support in relation to having been subjected to SV. The first part of the interview schedule involved a narrative approach,74 using a small number of open-ended stimulus questions designed to open up a conversation about victim-survivor experiences of services. This was combined with more traditional semistructured interviewing,75,76 where, once the narrative section of the interview was concluded, a second stage of more defined questions was asked.

Participants were offered the option of mapping their timeline diagrammatically to aid recall of their journey using a Whiteboard feature on Zoom. However, most victim-survivor participants (N = 23) chose to describe their timeline verbally rather than diagrammatically. The focus of the interviews was on the provision (and funding and commissioning – for the practitioner and commissioner interviews) of VSS services and not on details of the SV experienced. However, the sensitivity of the topic matter required that safeguarding measures were in place. If any participant shared information that raised concerns amongst the research team, an assessment of immediate and longer-term risk would be initiated. Examples of immediate risk included concerns regarding suicide risk, evident mental health distress, concerns for the safety of a child or adult. Conditions that mitigated the breaching of confidentiality by the research team were included in the participant information sheet and, for victim-survivor participants, support from their recruiting VSS service was available post interview if appropriate. No situation was identified that required the implementation of urgent safeguarding measures during the data collection phase. Members of the research team often debriefed with the principal investigator and broader team to ensure that consistency was maintained regarding risk assessment and management approaches.

Once the interview schedule was complete, or the allotted time was drawing to a close, the researcher(s) would complete their questions and allow the participant to provide any additional information they wished to convey or ask any questions. Participants were reminded of the support information on the participant information sheet and signposted back to their service for support. The next steps of the research process were explained to the participant, such as when they would next hear from the research team, and what actions would be taken. Participants were reminded of the option to amend their interview transcript in due course, and, where relevant, when they would receive their voucher for reimbursement. Victim-survivors were also asked to provide a name, should they wish to offer one, to act as a pseudonym that would be aligned with their quotes in final publications and presentations (see Appendix 2 for the participant pseudonym key).

Data creation and storage

With prior consent from participants, all interviews were audio-recorded. At the end of the formal stage of the interview, recordings were stopped by the researcher and the participant was offered an opportunity to provide feedback or ask questions without this element of the conversation being recorded. Audio recordings were sent for transcription by a transcription company registered with the Information Commissioner. The transcripts then underwent surface-level anonymisation. This anonymisation included the removal of people and place names and the addition of an anonymisation key when required. Contextual anonymisation – for instance, when a participant described identifiable features of their city, without specifically mentioning the name of the city – was not completed at this time but was noted within transcripts. When the transcripts were anonymised, they were returned to the participants either by default (victim-survivor participants) or on request (practitioner and commissioner participants) and these participants were given up to 4 weeks to confirm they were happy with the content of the transcript, make amendments or additions or ask for their data to be removed from the data set. After this time, non-anonymised versions of participant data – the original transcript and audio file – were deleted and the participant was no longer able to remove their data.

All information relating to participants was stored securely and participant keys were used to label individual files, rather than using participant names. Identifying details were kept in site-specific folders on a secure drive. When moving interview transcripts – for instance, between the transcription service and back to participants – the files were password-protected. In accordance with University of Birmingham’s requirements for the storage and retention of research data, study data will be retained for 10 years.

Co-production

Co-researchers were involved in the creation of the interview schedule, in the interviewing of victim-survivor participants and the analysis and write-up of victim-survivor participant data.

Individual site analysis

Analysis of the data formally started in conjunction with the final stages of data collection. An initial analytical framework was developed using both inductive and deductive methods – using themes from relevant literature. Two members of the research team (Gunby and Smailes) used approximately 10% of the coded data in the initial production of the codes and framework, and further transcripts were used to check the representativeness of the codebook after amendments were made. Initial divergences in coding between victim-survivor and practitioner/commissioner data were reconciled through an iterative process of development and amendments. A ‘final’ codebook was created, with the understanding that further small refinements might be made as coding progressed.

Victim-survivor data (other than a small number of transcripts that had been used in the development of the codebook) were coded by the co-researcher team after 2 days of training and guided support from members of the research team. After the initial 2 days, co-researchers completed the remainder of the coding of transcripts self-paced, with support and feedback from the research team. Practitioner/commissioner data were coded by the research team – in the most part, site leads took responsibility for the coding of their own site’s data. Feedback from the co-researchers and research team was encouraged throughout the coding process. Twenty per cent of the victim-survivor data and 10% of the practitioner/commissioner data were verified once they had been initially coded. There were slight additions made to text that had not previously been coded, but, in general, coders were in agreement.

Due to logistics and restricted access for licensed products such as NVivo (QSR International, Warrington, UK), the victim-survivor data were coded using Microsoft Word (Microsoft Corporation, Redmond, WA, USA). The analytical framework was the same as it was for the practitioner/commissioner data, which were coded using NVivo. On Microsoft Word, coders would add a comment to a portion of text they wanted to code with a particular pre-determined label from the codebook. Once the victim-survivor data coding was completed, the comments (code labels) and associated text were extracted from each transcript and collated for each case study site. This allowed the research team to sort the data by participant (using their non-identifiable number/code) and/or by code. A framework analysis was conducted at the completion of coding to determine the most used codes across all three participant groups, and all four case study sites.

Individual and cross-site analysis

Analyse the range, scope and funding of voluntary sector specialist services and how demand is managed

Figures 16 and 17 provide an overview of the sites.

FIGURE 16 Site overview diagram – features, population, demographics and CCGs/ICSs. (Figure not reproduced here; see the original article.)

FIGURE 17 Site overview diagram – VSS service set-up. Note: One SARC operates in each of the case study site areas. (Figure not reproduced here; see the original article.)

Case Site 1

Three VSS services operate across the county. Service 1 was one of the original Rape Crisis Centre’s in England, initially formed as a helpline and later registering as a charity. Service 2 was set up in the 1980s, while Service 3 was established in 2010. Each offer a range of services to women, men and children including ISVAs; helpline support; counselling for adults, CYP; group work; training and consultancy; community awareness; advocacy; play therapy, families work and creative and holistic activities.

Each service reported having experienced ‘a massive growth’ (S1.P5) in demand over the last 5 years (exacerbated by the pandemic). For practitioners, this was a major challenge: ‘It frequently feels overwhelming, that sort of relentless number of people coming in and wanting to do the best for all of them’ (S1.P5). To meet the need, services had grown and become reliant on a greater range of funding sources. However, the overall funding available had remained static (or been reduced), constituting a loss. In response, waiting lists were operating, spanning several months. Commissioners predicted that demand would intensify further, and this was considered to be the biggest challenge they faced. Concern was expressed that if more money was not made available from central government, systems which rank victim-survivors’ needs - in order to prioritise resource - may become necessary. In response to these pressures, practitioners were having to make difficult decisions to de-invest in certain areas, for example, the deprioritising of outreach work. Refusal to accept referrals from agencies where no explicit funded pathway existed was also considered likely.

Case Site 2

Sexual violence services across the region often lacked strict geographical boundaries, with victim-survivors engaging with a range of services, sometimes across borders. The main VSS service (service 1) in the area was identified as a ‘linchpin’, with the majority of local SV provision being provided through them (although other voluntary services in the area had some SV specialism). In turn, (service 1) had good working relationships with other local organisations (statutory and voluntary), creating a (mostly) symbiotic provision for victim-survivors. However, the service was operating to a 9-month waiting list, which has been noted as a challenge by both service providers and commissioners. The waiting list had  increased from 6 to 9 months following the pandemic.

The most significant funding and commissioning issues identified by the interview participants was the shortfall in funding required to meet the demand for services, and the associated struggle to fund long-term counselling. The commissioners interviewed were open and blunt about the stark gap between service need and service funding, and the lack of progress towards funding models that respond to the needs of the sector. Commissioners (and practitioners from services) described how demand has increased in the presence of funding cuts (and austerity), with waiting lists increasing sharply as a result:

There’s just not enough funding and not enough to be able to provide for everybody that really needs it. The bits of funding that we can get are a drop in the ocean compared to what is really needed in terms of that long term specialist support.

Case Site 3

A commonly cited enabling factor of joint commissioning and partnership working within the county in regard to NHS, LA and Police was the coterminous borders of the different organisations which enabled shared responsibility and decision-making for the county’s population. Practitioners and commissioners suggested that clarity and stability of relationships between these bodies confer advantages to the organisation and to the funding of SV services, underpinned by a ‘shared drive’ (OPCC Com) to improve support. An example included one dedicated VSS (Service 1), working with two ‘Local Partners’ to deliver specific, defined elements of support.

At the time of interviewing (December 2021–April 2022), Service 1 had, on average, a 20-week waiting list for its services. The length of the waiting list, Practitioner 4 told us, had ‘gone through the roof’ over the last year. It was previously 6–8 weeks. Service 1 practitioners signpost those waiting for support to the helpline (during office house), make regular ‘check in’ calls and offer advice and self-care tools to help manage difficult feelings and to support service users’ general well-being. Across its different therapeutic services, Local Partner 1 had over 500 young people waiting for support, an unknown number of whom were victim-survivors of sexual abuse.

Case Site 4

The local VSS (Service 1) is a major source of support for both women and men victim-survivors in Boroughs A and B and has recently extended services to cover a third borough. A male-specific specialist support organisation (Service 2), established for two decades, supports men and boys, particularly those affected by CSA. An ethnic minority male specialist support organisation (Service 3) was established a decade ago to support male victim-survivors of CSA and to intentionally fill the gap in culturally appropriate services. Services 2 and 3 are both grass roots and micro-sized, employing just one member of staff with minimal volunteer support.

In 2019, the OPCC commissioned an independent review of SV and abuse services in the area. Excessive waiting lists and delays in being able to access specialist support were identified as problems by practitioners and victim-survivors alike. All the VSS services had experienced a steep growth in demand for support in the last 5 years. Demand for services during the COVID-19 pandemic had risen particularly sharply. Providing long-term support was challenging for practitioners and it was difficult to adequately support ‘complex’ clients. In response to demand for counselling, VSS staff were offering sessions of emotional support, while clients waited for counselling to become available. Due to the general lack of culturally appropriate services, Service 2 had recently evolved to support minoritised men with a wide range of support needs and had started accepting clients nationally.

Cross-site analysis of victim-survivor perspectives

The under-resourcing of VSS services was recognised by victim-survivors, with an understanding that service provision is ‘all down to resources’ (Lavinia) and that this impacted the nature and duration of services accordingly. One participant, Mia, explained, ‘I’m on the edge of jumping off a bridge in a minute and I’m told “oh five or six months you’ll have somebody contact you”’. Some participants articulated the importance of managing demand while ensuring service user safety, recognising that long waiting times can leave people in crisis. Participants Findlaigh and Brooklyn both reflected that opportunities for long-term support and follow-up might currently be missing in the provision of VSS services but understood that ‘obviously they don’t have unlimited resources’ (Brooklyn).

Victim-survivors also recognised that VSS services require ring-fenced, sustained funding in order to enable services to continue the provision of specialist and effective support, and that this must be communicated from the ‘bottom up’ to commissioners: ‘I think that they are saving lives … they are crucial for our society … the fact that it’s just for SV and things, it makes it more tailored …’ (Blossom).

Participants identified a clear relationship between the numbers on the waiting list and the time limitations of the services they received:

with [Service], the free services, we got to the eighth session and it was very clear that I needed to carry on, we hadn’t barely scratched the surface, but it was very much well there’s only eight sessions and then you will have to go, like, will have to leave.

It is well recognised that ‘one size does not fit all’ and that the preferred ways of working within services, and the provision and delivery of specialist support, will vary between VSS services and across victim-survivor groups. For example, there were differing views regarding telephone support: ‘I think I actually did ring one once but … I just didn’t really feel it from them’ (Mia), compared with Blossom: ‘a helpline that is open 24/7 … would be really helpful I think just while people are waiting for that support’. Recognition of the heterogeneity of victim-survivors, their preferences and experiences highlights the importance of offering different service models within a specialist service: ‘This is not something that’s kind of like a broken leg, it’s not one treatment that’s really good for everyone’ (Findlaigh).

Explore the usefulness of different approaches to service delivery and different therapy models

Case Site 1

In this site, the number of counselling sessions per victim-survivor was not specified in contracts, and instead left to each service to negotiate. Therapy was generally between 6 and 20 sessions, with victim-survivor needs and wishes being reviewed and sessions extended if necessary. With a focus on exploring the impact of abuse, therapy was non-judgemental and empathic and believing victim-survivors was fundamental to the therapeutic approach. Therapy of this nature was said to have the potential to ‘change someone’s life’ (S1.P4),  with victim-survivors describing it as impacting ‘your life in a way you would never have thought [possible]’ (Selasie). Its delivery was also recognised to take ‘real skill’ (Margot).

The transition of counselling services online to provide support throughout the pandemic, and the option of a more blended approach once services returned in-person, was flagged by all as beneficial in enabling support to continue. While a blended mix offered greater flexibility, practitioners, however, spoke about the emotional challenges of providing online provision:

I don’t think it’s good for anyone to have to do this, any sort of type of this from home, because you are dealing with a lot of trauma in your own home and your home should be your safe place … And for service users, I don’t think they should be talking about it in their home …

The Partnership in this site were commissioned to deliver Crisis Talking Therapies to SARC clients. Talking Therapies was up to 12 weeks duration and often delivered very soon after the abuse had occurred. While described as ‘valuable’ in certain cases, there were multiple practitioner concerns that it did not meet the needs of victim-survivors. This was because the point at which it was offered was ‘not the best place in the person’s journey … it’s not what they’re ready for’ (S1.P5): a perspective supported by independent evaluation. It was argued that weekly practical/emotional support would be more beneficial, with counselling commencing later. However, as stood,practitioners had little agency to use their expertise to influence the current delivery model.

Case Site 2

Counselling was provided by Service 1 using a trauma-informed approach, in-house and across three sites (two drug services and a sexual health service - see below). They provide counselling for both children and adults, and to people of all genders. Children receive up to 24 sessions of therapy and adults receive 16 weekly sessions. Service 1 also deliver crisis counselling for the regional SARC. This latter provision was noted for its swift response but was described as ‘holding’ (S2.P3) the victim-survivor until other services are able to engage, or the victim-survivor can take up other service provision. There is an extensive amount of support and outreach work that happens across the region, mostly provided by Service 1. Support workers provide a broad range of advice and guidance, particularly around housing and benefits. They are often a ‘bridge’ when there is a counselling waiting list (S2.P4). There are several support workers from Service 1 that are co-located in other services, including sexual health and two drug support services. This co-location has proved important to the overall local sector (S2.P1,4), aiding with referral support and the host service receiving ad hoc advice and support outside of individual situations.

It was specifically noted in interviews that psychoeducation was a useful approach in therapy:

The biggest thing for me was education really, they taught me why my body was responding in certain ways and up until that point I just thought I was going mad, so to learn about post-traumatic stress and the effects that trauma has on the body, I even attended training as well while I was there, so that was really helpful.

This participant’s new understanding around the somatic effects of trauma created a reassurance in the victim-survivor that their response was a normal one. Linked to this feeling of ‘normalisation’ that being part of a VSS service can offer, Gen commented, ‘… there’s other women that are going through this … I’m not on my own … it does make you feel better … So just how important it is to have this community’.

Case Site 3

Volunteers play an important role in the organisation, primarily as volunteers on the helpline and engaging in fundraising activities. The positive influence of having volunteers, peer support workers and workers with lived experience was noted in relation to a negative experience for one participant in ‘other services’ they had accessed previously: ‘it was different … I’m not sure if that person had the same experiences or could relate as much as like the volunteers or support workers in the crisis centre’ (Victim-survivor 1).

Victim-survivors appreciated the range of therapeutic approaches on offer within the service, reflecting that ‘it’s not just the support sessions, it was so much different types of support’ (Blossom). This recognises, as mentioned previously, that one size does not fit all within VSS service provision and delivery. Counsellors at Local Partner 1 are ‘trained to work with trauma and abuse, not as a speciality, but as part of the core training’ (S3.P6). Practitioners who do undertake specific SV focused work do, however, receive additional training, for example, about sexual abuse disclosure and pre-trial therapy. Local Partner 1 describes their therapeutic model as an integrative client-centric model that draws on cognitive–behaviour therapy, acceptance and commitment therapy and solution-focused therapy, as well as creative strategies such as play, art and drama therapy.

Like Local Partner 1, Local Partner 2 staff understood their specialism to be in working therapeutically (often in a psychodynamic way) with people who have experienced trauma, rather than working exclusively with victim-survivors of SV. Staff we interviewed were confident about the transferability of their skills and indeed these practitioners did have considerable experience and interest in working with victim-survivors specifically. However, it was acknowledged that, outside of the VSS service, not all staff would be able to work confidently with victim-survivors and we were told that some staff in the patner agencies had opted not to, as they did not consider themselves sufficiently skilled in this area of therapeutic work. Both ‘non-specialist’ organisations (Local Partners 1 and 2) invested considerable time and resource to support staff working with victim-survivors and talked about this as an ethical imperative. However, it was clear that additional training and supervision to upskill were provided in response to staff need, rather than being required by funding or commissioning bodies.

Case Site 4

The main support provided and discussed by practitioners was therapeutic counselling and advocacy (i.e. ISVA) services. Therapy was person-centred and compassionate. Therapeutic services provided by one of the services consisted of one-to-one specialist (trained) counselling, a 15-week group therapy programme, or emotional support sessions or alternative therapies if in-depth counselling was not required/appropriate. Counselling comprised up to 10 sessions; however, it was negotiated and reviewed on an individual basis. Practitioners noted the positive benefits of specialist counselling: ‘you watch them [victim-survivors] kind of grow’ (S4.P5).

With the ‘standard’ therapy provision offered, Sabir noted how they appreciated the individualised approach to the number of sessions received: ‘they said it were 10 sessions, but I needed about six or seven, I felt a lot better in myself after six or seven sessions. That was because they listened to me. I gave him everything I owned basically. They listened to me’.

All the services who took part stressed the importance of flexibility in the nature and content of support offered. The male specialist services in particular emphasised that not all clients wanted to talk specifically about abuse experienced and valued different approaches, such as befriending [offered by (Service 2)] and opportunities for connection: ‘[victim-survivor] said, yeah, do the befriending, I don’t want to talk about abuse, I just want to talk about football’ (Service 2). Adopting this tailored approach was crucial to avoid losing clients and for victim-survivors to build trust. In addition to its counselling, Service 3 offered walking groups as a safe space for ethnic minority clients who may lack the cultural language to express abuse experiences and were helpful for wider symptoms such as depression.

Cross-site analysis

Despite these positive reports, the complex nature of sexual trauma can necessitate longer-term support, in light of which some victim-survivors recommended not putting a limit on support duration because some individuals will need ‘so much more than … 20 weeks of support’ (Lavinia). It was a comment from one victim-survivor that appropriately summarised the problem with long waiting lists and time-limited support by saying ‘recovery takes time’ (Tracey). Further, concern was raised by one practitioner about the person-centred counselling modality and how it could sit in tension with the linking back of SV to systemic inequalities and the experiences of multiple women. In focusing in on the individual, the approach could sometimes marginalise the cultural, social and structural – key areas of focus for the SV movement: ‘that one-to-one individual focus stops you doing the bigger picture’ (S1.P6). In addition to informal support, all levels of participants – victim-survivors, commissioners and practitioners – recognised the benefit of the specialist nature of VSS services, which seemed integral to the service provision.

Explore how different principles underlying service provision influence service delivery, including feminist and trauma-informed principles of care

Case Site 1

Services’ independence from state-led organisations was further considered central to their ability to engage victim-survivors and, in so doing, provide an alternative to statutory provision. Independence from state bureaucracy was seen as crucial in enabling services’ agile and flexible response: ‘… our partnership work with other agencies, they can’t bend because of strategies and things that come down from their national bodies, they’re very rigid and fixed’ (S1.P1). Although confined by funding pressures, practitioners described VSS services as able to respond quickly. Something commissioners saw as distinguishing: ‘I find that there is less flexibility and the opportunity to adapt [with a private provider] than working with the third sector’ (S1.F/C2).

Case Site 2

Site 2’s strengths-based approach attempted to deliberately resolve some of the effects of the medical model response that denotes the individual as flawed:

It looks at what is strong with the person rather than what is wrong with you … if we turn that around and look at this is what you’re suffering now, it’s a positive coping strategy, this is what’s strong with you, we can build on this and we can build more strengths.

Here the practitioner explains that, using this strengths-based principle, the mental health responses of victim-survivors to trauma can be identified as reasonable responses to external violence. They went on to discuss that these responses could be, at times, protective mechanisms, and helping victim-survivors identify these strengths is powerful and allows for the identification and development of other behaviours, drawing on these strengths as a base. This method of psychoeducation was appreciated by victim-survivors using the service, as noted in the narrative above. Their model was praised by the commissioners, who stated that, ‘They know that the waiting lists are long so they know that people can access the helpline support and they check in with people, so it really is, I would say, the strength of the service is really being that victim-survivor-led, trauma-informed support for people’ (S2.F/C1,2).

Case Site 3

Service 1 staff in Site 3 were able to make comparisons in underlying principles of service provision due to previous work in the statutory sector. Experiences of working in statutory services were often described through reference to machinery and automation, in the context of a high (pressured) workload. In contrast, there was greater emphasis placed on creativity, ‘high-quality work’ (S3.P4) and a culture of care in the voluntary sector. Within Service 1, this resulted in an enhanced sense of staff well-being and belonging that fed into a collective commitment to go ‘above and beyond’ for clients.

Case Site 4

Practitioners typically had lived experience of SV and Service 2 described itself as service user led. Having lived experience was seen to bring a ‘deeper understanding’ (Service 1), commitment and passion to services (although was not a requirement for staff or volunteers). It also contributed to a more ‘equal relationship’ (Service 2) which was important for victim-survivors who often felt powerless.

Cross-site analysis

Across the four sites, there were a number of consistent principles underlying service provision, noted by practitioners and victim-survivors. Services in all sites referenced being led or driven by feminist principles, or ‘recognising that sexual violence is based in misogyny, patriarchy and having that political perspective’ (S1.P1). As part of the feminist work services did, activism and the translating back of victim-survivors’ experiences to policy-makers took place. While described as essential for placing frustrations into a tangible outlet, it was noted that this activity had reduced across the sector: ‘I’m just thinking about Rape Crisis member groups … a lot of groups are so busy trying to survive that they don’t communicate and influence their local structures well enough’ (S1.P6). In Site 4, all RC staff and volunteers underwent a 7-week CPD accredited training course which introduced them to theories of feminism, oppression and support skills. Being male-specific services, Service 2 and Service 3 also addressed shame issues within therapeutic services, but did so from a ‘humanist’ and ‘gender-informed’ perspective, which recognised the particular challenges for men in sharing sexual abuse/violence experiences and toxic notions of masculinity which may inhibit disclosure, at the same time as recognising that men were more likely to be perpetrators of SV/abuse. Even without specifically being defined as feminist organisations, Local Partners in Site 3 reflected that there were commonalities in how staff at all organisations characterised their commitment to be victim-survivor- (or client)-led. Recognising and responding to individual, sometimes complex needs of victim-survivors were consistently highlighted as a defining feature of each service, rooted in a commitment to relational, ethical practice. As Practitioner 3 commented:

I’d like to think we don’t treat people as in a sausage factory almost, you know, like next, next, next! There is a level of flexibility … with the feedback we get from clients, they’ve told us that we are providing them with what they need.

This ethos around being victim-survivor-led and person-centred was also reflected consistently across sites. In Site 3, victim-survivors were aware of these inherent underlying principles in use throughout the work, namely in terms of the way the support felt. One description seemed to fit with a holistic and person-centred approach, ‘… honestly, I just felt so understood and kind of, like, I didn’t have to explain things and, you know … that was really helpful as well’ (Autumn). In Site 1, service user co-production groups, surveys and focus groups were used to generate victim-survivor insights, with victim-survivors valuing this approach. An ‘online victim-survivor service users forum’ was highlighted as a way of enabling service users to ‘shape and direct and put what they want into the charity and that’s just really empowering’ (Mandy). In Site 4, the need to respond to individual needs was reflected through the development of the ethnic minority specialist support organisation (Service 3) which sought to challenge racial and religious prejudices that marginalised ethnic minority male victim-survivors experienced and prevented them from accessing statutory support. Identifying as secular and evidence-based was considered to be important for its legitimacy with clients who had different religious backgrounds, and/or who viewed religious institutions as upholding systems of racism. Staff explained that understanding how certain cultural or religious concepts may prevent recognition, awareness or expression of experiences of SV was essential for initiating and developing relationships with clients and engaging with them in a way that mainstream services could not.

Working with and for victim-survivor needs was considered to be very strongly linked to belief. Blossom (site 3) reflected that while accessing support from another service, they were told ‘well that’s not what happened’, whereas when they were supported by Service 1: ‘I could have told them that I saw a pink elephant walk down the road and they would have been like “yeah OK” and just run with it kind of thing’. This was also echoed by Lucy from Site 2 as they describe how ‘you’ve never had to prove yourself, like … what you’ve been through, like with the Police and everything else, you’ve had to prove it, but with [Service] you don’t’. The experience of being believed, without providing evidence, held weight: ‘… when you believe somebody’s story then you’ll be able to know what kind of help the person needs, where to signpost the person and how the person can go about it.’ (Ava).

The specialism held by the services across the case sites also cannot be underestimated. VSS services’ specialism – or intrinsic, unspoken understanding of sexual trauma – was described by victim-survivors as key in contributing towards positive experiences: ‘you didn’t have to explain to them, they knew what you were going through’ (Lavinia). It is of note also that even when victim-survivor participants may not have recognised ‘trauma-informed care’ or ‘feminist principles’ at work, they often recognised and appreciated the specialism of the service:

I think my therapists were both very, very good talking about sexual trauma, my relationships with men and my body and how my body responds to triggers and all of these things, that was all very informed and they clearly knew everything about that.

Perhaps it was the coming together of these values and approach that produced in staff a willingness to go ‘above and beyond’ (S1.P2). Multiple practitioners spoke about their commitment, care and passion for their work, albeit hard work. Features that show up in the interaction with service users: ‘clients, they get that people are passionate, they feel that they know people care’ (S1.P2). The coming together of these unique ways of working, combined with a primary focus on, and deep-seated expertise in SV, underpinned the meaning of the term ‘specialism’. It was this combined approach which differentiated VSS services from the support offered by statutory, private or more generic organisations and why, budgets permitting, certain commissioners expressed a commitment to the future investment in specialist services.

Investigate referral patterns and pathways, and how voluntary sector specialist services fit with each other and link to the wider network of services for victim-survivors

FIGURE 18 Site overview diagram – local structures and partnerships. (Figure not reproduced here; see the original article.)

Figure 18 shows an overview of the local structures and partnerships across the sites.

Case Site 1

As discussed, the three services in this area had formed a formal Partnership. While born out of necessity, there was overwhelming agreement that it had been a positive change in terms of operational practice and support provision. It was argued that it was now possible to ‘offer a quality, uniform service across the whole county’ (S1.P1), with commissioners/funders stating that they did not have ‘to worry about a postcode lottery’ (S1.F/C6) of different levels of care.

Operationally, partnership working had allowed VSS services to share their skills, have a collective voice and ‘much more clout when it comes to asking for funding’ (S1.P7). It was recognised that funders/commissioners preferred and, in this area, expected a partnership approach: ‘… what we recognised was that commissioners preferred to work with one representative, so they don’t like it if they’re having to talk to different partners …’ (S1.P9). Due to these collective practices, the Partnership had developed, as outlined, a cross-service initial point of contact or ‘triage’ model. Inspired by international practices, this approach had helped mitigate certain risks of having small teams working purely within one service. The triage model had also supported improved response times and a seamless approach to referral. Indeed, referral into VSS support via the police, for those victim-survivors who had come through this route, was reported to be very effective. However, certain victim-survivors stated that the VSS services ‘can be hard [to find]’ (Selasie) if self-referring. Indeed, few victim-survivors had awareness of their existence prior to being subjected to abuse and this is where signposting by key organisations can become crucial. As Selasie stated, ‘they would never have gone to [service]; it was only because the police referred’.

Case Site 2

There were strategic projects and cross-area aims to aid strong service provision in this site. For example, the area had a newly developed SV consortium, comprising Service 1, two other SV services, the police and NHS. This has encouraged more connection and discussion between SV services and statutory services. For example, Service 1 was contracted to provide SV training to the police, and to provide critique and feedback on new SV-related policies. The region also includes a Domestic and Sexual Abuse Board that meets bimonthly, including VSS and statutory services, as well as commissioning representatives. The commissioning group is aiming to drive forward the local SV agenda and improve patnership working and collaboration. The CAMHS practitioner in this site also explained that a few years ago, the DH funded a review into connections between CAMHS, SV services and the LA. This review found that most CAMHS clinicians did not have the knowledge about SV to adequately identify and treat. The outcome was a substantial training package that has improved the skills and confidence of the CAMHS workers, alongside positively influencing the collaboration and pathways between services.

Trust and familiarity between services is key to good referral pathways and maintaining confidence in those services. Many of the key individuals across services (both VSS and statutory) in this area have been in post for a decade (some for much longer) supporting a strong sense of stability andreliability. One practitioner stated that:

These services were set up years and years and years and years ago … these links have been in place for years … and the main players don’t really change. And I think that possibly adds to some of the stability … of how we worked together.

Case Site 3

The three voluntary sector services that provide specialist support to victim-survivors are independent organisations, with no connecting formal partnerships or agreements. A perceived advantage of this was that each service retains its unique identity and service remit. In addition, the services are not, in the main, in direct competition with one another for contracts or pots of funding when it comes to SV-related work. In 2019, the OPCC established the County’s Sexual Violence Partnership to help deliver its SV strategy and to raise the profile of SV in the county. The Partnership was set up to enhance joint-working, referral pathways and professional relationships between organisations with shared interests. The main partners are Service 1, Local Partner 1 and Local Partner 2 and the SARC. Practitioners described the Partnership as a useful forum to share knowledge and learn about one another’s services and areas of specialism. As Practitioner 6 described: ‘… we get together and share information, providing we’ve got client’s consent to get them the best possible support, yeah, which works really well’ (S3.P6). The Partnership also provides a regular space for communication between commissioners and service providers and was valued by all parties for helping to raise issues in a timely way and to increase transparency about funding and commissioning decisions.

It was reflected that SARCs in this area regularly work alongside the VSS services and often represent the entry point for victim-survivors: ‘so I went to SARC, saw [SARC Staff] and then I think it’s through Service 1, they do the twenty-four-week counselling that I did with [Service Staff]’ (Mia). Both SARCs and VSS services work closely with the criminal justice system if a victim-survivor should wish to pursue this option: ‘And with [VSS service] as well, I appreciated the fact they don’t push you to contact the Police at all … if you want to report it – they offer, like, different ways of reporting it’ (Blossom). Reasons for not reporting are varied but may include Blossom’s experience: ‘… I just know for a fact that I wouldn’t have a leg to stand on in the justice system’. The reality for many victim-survivors is that few SV cases reach the stage of prosecution and then conviction, making some very reluctant to report.

Case Site 4

Organisations in this site described ‘reciprocal’ relationships that involved referring or linking victim-survivors to other VSS services and collaborating to hold one-off joint activities around specific initiatives or issues. These informal relationships were vital for managing victim-survivors’ needs at different points in their journey and being able to signpost appropriately.

There were also more ‘formalised’ relationships and partnership arrangements in place. For example, an action partnership for SV existed between Service 1 and Service 2 to raise awareness and provide a platform to work with commissioners; however, differences in priorities for different victim-survivor groups (girls and women, and men) had so far prevented further formalisation of the partnership and any specific joint commissioning arrangements.

Both Service 2 and Service 3 were members of the Male Partnership Board which provided a link to policy-makers and connections with other organisations. However, Service 3 was cautious in its relationships with other VSS and statutory organisations to preserve its acceptability to victim-survivors:

if we’re going to support people from these communities one of the things you have to be careful of is delegitimising your service. So, one of the things that we certainly don’t want to do is overly befriend [statutory organisations] …we keep it to a minimum.

Cross-site analysis

Referrals to VSS services across all four sites were either self-referrals or agency referrals. Self-referrals were particularly common for the male specialist support organisations in Site 4, but both had received some referrals from Victim Support, GP networks and local homelessness, drug and alcohol agencies. Service 2 attributed a large number of self-referrals to its digital outreach work.

Exploring referral patterns and pathways into VSS services with victim-survivors exposes a diversity in the journeys that people have taken to arrive there. In Site 3, Autumn’s reflections demonstrate one type of journey into specialist support: ‘I got support through my private insurance company … probably … ten sessions … I was on the waiting list with [Service 1] and then I had these sessions …’. Long wait times for VSS services may mean that victim-survivors need alternative sources of support as they wait, as it was for Blossom who ‘also paid a private counsellor’.

For practitioners and victim-survivors, however, referrals were not always straightforward. Experiences when initially accessing VSS support can be varied. Those victim-survivors who reflected positively cited how it was an ‘easy process’ (Brian), and how they ‘very quickly [got] through to the right people’ (Aadava)). The latter experience, however, was considered by the victim-survivor to be based on luck and not necessarily what they thought would be the norm: ‘I think I’m just one of those fortunate ones … I was one of the lucky ones, because it wasn’t really directed from the GPs either’ (Aadava)). This perception was mirrored by a different participant who described the systems around accessing support as not ‘completely broken – but it’s not joined, you know, from one service to another and it’s all higgledy piggledy’ (Toby). In Site 1, concerns were raised by practitioners in relation to certain referring organisations and practices. For example, with mental health, while there was a reported ‘willingness … to work very constructively together’ (S1.P5) in certain areas of the county, it was argued that VSS services were receiving many referrals from mental health – ‘not all of them are appropriate’ (S1.P5) – and often without any remuneration: ‘… Health, they make 17% of referrals into [Partnership] but pay for 1.6% of those referrals’ (S1.P1). Practitioners argued that a funded pathway and a better understanding of each services’ thresholds of work could potentially improve these relationships.

Explore victim-survivors’ experiences of accessing and using voluntary sector specialist services, identifying what needs are being met for which groups of victim-survivors and what encourages victim-survivors to take up services

Case Site 1

Victim-survivors had positive experiences when accessing and using VSS support and noted services’ propensity to go ‘above and beyond for every single person they meet’ (Margot). Victim-survivors’ relationships with their practitioners, the physical environment and specialism of workers were all factors identified as contributing towards positive outcomes.

Certain victim-survivors described their workers as having ‘probably saved [their] life’ (Margot), reinforcing the integral nature of the relationship/connection between the worker, service user and recovery process. Described as ‘almost like talking to a friend’ (Pippa), the positioning of the practitioner on a level equal to that of the service user facilitated the growth of a connection that transcended the power imbalances that can underpin certain client/professional interactions.

Case Site 2

Accessibility of services was specifically discussed by several participants. Gen reflected that ‘I’ve never done therapy before … I don’t feel like working class people have that opportunity’; furthermore, they stated, ‘I think the world of therapy in general is just so inaccessible’. Lack of knowledge of service provision was also considered a barrier: ‘So I initially just started looking for therapy … in general … I just had no idea where to start … the priority for me is the sexual violence’, explaining, ‘they seemed to be much more experienced in dissociation and things like that’ (Millie). The cost of a service is often a consideration: ‘one of my friends said to me “I can’t afford therapy” … and I said, “I’ve just had … sixteen sessions at [Service] and it was free”’ which encouraged their friend to access VSS support. The same participant explained, ‘I am in a privileged position where I could pay for [pay-to-access service], but a lot of people aren’t, especially in the current financial climate’ (Gen). Importantly, though, Gen reflected how the quality and experience through the VSS (free-to-access) service and the pay-to-access service were as good as each other.

Case Site 3

Even with awareness of services, victim-survivors’ personal reasons for accessing support can vary considerably. Engaging with VSS services may be the result of a chance comment to the right person: ‘the first time when I actually was able to say out loud to someone that asked what happened … they suggested the women crisis centres and this is how I found [Service]’ (Autumn). This may be especially valuable when victim-survivors do not feel as though they can or should address what has happened, until perhaps there is a trigger for them:

throughout my whole life I suppressed it so much that I think I also convinced myself like nothing ever happened. And so I never even thought about it, like, I never told anyone about what happened … only when I was kind of already in my, I don’t know, like 20s, and I started dating and then sometimes something would kind of, like, a memory comes up.

If participants were more aware of the services on offer, they could not only be involved in decision-making about the most appropriate form of therapy/support, but for services themselves, it may create a more seamless and timelier journey through the VSS system:

And so if you suffer from this, we’ve got this kind of thing, if you suffer from this we can offer you this … I’d never heard of EMDR until last year and it took me about six months to understand what EMDR stood for.

Case Site 4

What supported victim-survivors to reach out to VSS services included seeing ‘an advert, and it was about mental health and stuff and [they] just really related to it’ (Karl) and hearing ‘on the radio … “are you a male victim-survivor of sexual abuse and, if so … we can help” … it was surreal when it came on’ (Sam). Aadava spoke to the importance of an accessible service, related to paying for support, comparing a national service that charges a nominal fee – ‘I just didn’t bother going in’ – with their local VSS service who responded quickly and with ‘no cost involved at all’. Karl also reflected that the fact the VSS service ‘didn’t cost £50 a session’ was a strong motivating factor for their engagement with the service. For Brooklyn, it was a friend’s father having ‘gone through a similar thing when he was younger’ so their friend was aware of a service that could help.

There were positive experiences and outcomes from VSS support also reflected by victim-survivors, including ‘the biggest takeaway would be like an increased self-awareness and ability to look at [themselves] objectively and manage [their] behaviour’ (Brooklyn). For Brooklyn, the gravity of the experience and outcome of support could not be underestimated: ‘I’d say, to some degree, it saved my life getting help from them’. In this case study site specifically, there was a larger proportion of male victim-survivors compared with female. Given this, it was interesting to see reflected the extent to which some male participants considered the needs of other male victim-survivors as having been met, or not, as influential to their decisions to seek support. Findlaigh reflected how he ‘wasn’t even sure there would be support available as a male victim-survivor’. He considered the perceived ‘skew’ towards female victim-survivors to be understandable, and not upsetting to him, but he reported that there at least needed to be more awareness for services and support ‘in whatever form it takes’ for men. Findlaigh considered himself to have ended up with a positive outcome, but was concerned that for other people, ‘that might not be the case’.

Cross-site analysis

Most participants reported waiting several months between referral and commencing counselling provision, although a minority accessed it ‘pretty much straight after’ referral and ‘within about six weeks, six to eight weeks of applying’ (Lottie). This underscores the mixed experiences that can be based on waiting list times. While having to wait was understood by victim-survivor participants, it does highlight, again, the risk around delayed access. For one participant from Site 4, a point of crisis was a motivating factor for accessing support: ‘it wasn’t until one Sunday there I found myself popping my pills and again trying to commit suicide, so my wife brought me back home and said, “Look, you’re going to have to get help”’ (Levi).

Therefore, victim-survivors were cognisant of the effect of decision-making from commissioners and the influence of their funding decisions for the service users. The main impact of funding for all participants appeared to have been in wait times for a service, with a sometimes-significant impact on victim-survivors. While there was an appreciation that ‘the waiting list is very long’ and that the financial constraints the service worked within caused the staffing issues, it nevertheless had an impact.

Explore how arrangements for commissioning and funding services for victim-survivors across health, local authorities and criminal justice have evolved over the last 3–5 years and how they have impacted on voluntary sector specialist service provision

Case Site 1

Perhaps unsurprisingly, the problems of short-term funding were raised by all practitioners. Such funding was said to not recognise that ‘to embed other services, drop-ins, social groups … they need to be given a long time to actually embed and grow’ (S1.P8). Short-term funding produced a context of living ‘hand to mouth’ (S1.F/C3) and distracted from activity focused on developing services. The stress this context engendered cannot be underestimated: ‘I can’t express enough how terrifying it is each year or each couple of years when we know funding is running out or ending, can we sustain the service’ (S1.P2).

Despite good relationships with engaged local commissioners/funders, there was broad criticism of the commissioning agenda, which was said to have introduced generic and private providers and the treat of ‘takeover by bigger, more funded organisations’ (S2.P6). With commissioning came the work associated with writing tender responses and going through recommissioning processes, with a lack of flexibility with the latter being noted. For example, despite being the only large-scale specialist provider in the area, one with a track record of delivering, procurement wavers were infrequently used to support services from having to re-engage with the recommissioning process: ‘so it’s like OK well there’s a quality service, there isn’t a competitor that is specialist in the area, why are you putting it out to tender, why are you putting us through that!’ (S1.P1).

Despite commissioning becoming embedded into local infrastructure – and the necessity to comply – questions in this area existed as to whether sexual abuse was a crime ‘problem’ and the responsibility of the PCC to fund, a public health priority, implicating the LA, or a long-term health concern necessitating NHS or CCG input. In a context of squeezed commissioner budgets, this ambiguity had resonance. However, improving clarity on this point will not necessarily be enough to shift this situation, with a failure to understand the potential long-term trauma of sexual abuse, what VSS services do or their complementary approach to ‘a clinical service provider’ (S1.F/C2), also driving investment decisions.

Case Site 2

Arrangements for commissioning and funding across the region were described as having a significant effect on the services provided, both intended and unintended. The annual cycle of commissioning was identified by most of the practitioners, and described as a huge challenge, as it does not encourage planning or embedding service in a community (S2.P1,2,4,5, F/C1,2). A practitioner in Service 1 was frank about the chilling effect of this cycle on innovation and sustainability:

So the PCC, for example, give us large funds, but every year we’ve got to bid for them, at the end of every year, I’ve explained this uncertainty, a year is not enough to launch a new service or to embed an existing service or grow and develop it.

Commissioners agreed with this sentiment, stating that ‘at least if they [SV services] know that they have two- or three years’ worth of funding it gets into a system and it is that stability then for the staff and for the actual support as well, it would be much better’ (S2.F/C1,2).

Practitioners identified that austerity measures substantially contributed to the challenges for all services, both statutory and voluntary. One practitioner noted that, ‘I think we’ve lost an enormous amount of capacity in the specialist services because of the economy and because of cuts’ (S2.P2), with another arguing that one of the reasons services did not get enough funding to provide support was ‘due to funding cuts’ (S2.F/C1,2), and a further suggesting that austerity has reduced their funding by ‘about 20%’ (S2.P4). Services have deliberately diversified their funding model to address these issues. In order to facilitate this more diverse funding approach, grant bidding and fundraising has become ‘a significant element of the organisational model’ (S2.P4), with the introduction of dedicated staff posts that had specialist skills in identifying, applying for and winning awards.

Case Site 3

Unusually in Site 3, while several services were commissioned (e.g. ISVA and some counselling provision), other aspects of therapeutic and emotional support work remained grant funded, although there were indications that this may change in the coming 5 years. Practitioners and commissioners underlined the positive nature of their working relationships, characterised by an understanding of their respective roles, regular communication and the ability to work cooperatively within the Sexual Violence Partnership: ‘We have a very good relationship with them (commissioners), yes, we get on really quite well. We meet the deadlines, we meet the spec, we do what it is what we’re asked to do … I think it’s about communication with people and picking up the phone’ (S3.P4).

Case Site 4

Concerns were expressed that funding pressures prevented more collaborative working as organisations were forced to compete with each other over limited funding. This was particularly pronounced in this case study area because organisations were focused on distinctive victim-survivor groups and priorities. Service 2 explained it experienced particular difficulties in negotiating with commissioners because it identified as victim-survivor-led and was therefore seen as too ‘subjective’. Victim-survivor-practitioners could, in turn, find these dynamics personally triggering and retraumatising. Relying on grant-making foundations was not considered to be sustainable, but both Services 2 and 3 struggled to access statutory funding. Service 3 considered itself limited in available funding sources, due to concern over its legitimacy with clients. It furthermore reported that minoritised services had only recently been recognised within government priorities and were an ‘after-thought’ (Service 3). Funders were perceived to lack a genuine understanding or commitment to support ethnic minority victim-survivors.

In addition, the main commissioner in this case study area (NHS practitioner) echoed the challenge that the lack of a national strategy for SV presented:

… if it’s something like sexual assault and violence there is no expectation. There is no funding allocation. There is no metric associated with it. So even having the transparency as to whether we’re good, bad or indifferent, doesn’t exist really.

Cross-site 5

Short-term funding underpinned the status quo for the VSS services. A picture that had worsened in the last 5 years due to applying for more money, from different sources, to meet the shortfall left by increased demand. For clients, the closure of services could result in discontinuity in support and the extension of waiting times for available services, both of which could come at a psychological and practical cost to the victim-survivor: ‘I’m just like “when that project runs out what about those people?” – I think that’s really, yeah, unsettling’ (S3.P2). Practitioners likened the challenges of short-termism to ‘running around on a hamster wheel of grants’ (S4. Service 1.P3) and uncertainty and insecurity were normalised. Practitioners also highlighted how the precarious nature of multiple, short-term funding limited practitioners’ job security and, concomitantly, sense of well-being. This was a particular concern at Service 1 (in Site 3) – the only dedicated specialist provider – who employed very few staff on permanent contracts and who had an exclusively female workforce, many of whom were the primary wage earners in their household. A situation, Practitioner 4 described as one that was ‘difficult to swallow’ and made employee terms and conditions a priority in contract negotiations with commissioners: ‘I think that’s sort of, my job is to be concerned about all the staff here’s mortgages and livelihoods without looking like it’s what I’m thinking about’ (S3.P4).

The most significant funding and commissioning issue identified across the participants was that there was not enough funding to cover the demand for services, and the struggle to fund long-term counselling:

There’s just not enough funding and not enough to be able to provide for everybody that really needs it. The bits of funding that we can get are a drop in the ocean compared to what is really needed in terms of that long-term specialist support.

Key messages from work package 3

• There needs to be a greater recognition of the unique value of independent, VSS services in providing flexible and responsive support, using a victim-focused, trauma-informed approach and representing the voices of victim-survivors.
• For victim-survivors, there needs to be more effective promotion of VSS services for the benefit of enabling them to become aware of the services and make informed choices about engaging with them.
• There should also be a genuine commitment to work with victim-survivors to co-produce services to avoid retraumatisation.
• Referral pathways between services must be clear and effective.
• Partnerships appear to work well in terms of connecting the VSS services and statutory (e.g. NHS) services with each other, and with commissioners. Partnerships should offer a space to share knowledge and resources, dedicate time to think through ‘complex’ individual cases and to work collaboratively on strategic and financial issues.
• Partnerships should offer a layer of support, accountability and structure to existing ‘good’ working relationships and should raise the profile of SV across the area. However, relationships between services can break down when there is competition over funding provision.
• Resources for supporting victim-survivors with ‘complex’ needs must be better understood and provided, to support partnership working.
• Long-term sustainable funding for the sector is required. Not only would this reduce waiting lists and increase the speed of service access, but it would also allow for longer-term support where needed.
• Commissioning in ways that understands and favours specialist services, is needed for example, by scoring weighting to recognise the importance to specialism and local knowledge, would support services to grow their provision in line with demand, and would ensure victim-survivors were accessing the most specialist support.