Opinion: Muzzling? No, just normal relationships

Peter Cardy, chief executive of Macmillan Cancer Relief

At an Acevo awayday with senior civil servants, debate shifted to service delivery versus campaigning. Charities that deliver services paid for by the state at any level often assert that they can neither campaign nor criticise their paymasters. I first heard this two decades ago from a charity providing breaks for disabled people. "We hate their policies, but I have to keep my mouth shut," said the chief executive about his funders. "Speaking out could lose hundreds of disabled people their breaks."

In fact, it's often not a case of muzzling or censorship, but just normal human relations. If you're a nail in the shoe of another organisation, it will try to avoid the pain and change its shoes. If you're too hard to work with, it will simply go elsewhere. If you slag it off in public, it will try to give you less access. If those relationships are the vehicle for grants or contracts, ending or diminishing them can have financial consequences.

This is true even if you are not under contract. Consider Macmillan, which gives tens of millions of pounds annually in grants to other bodies for innovation and improvement in cancer care. The four separate UK NHSs are the biggest recipients. The usual relationship is upside down: Macmillan is the grant giver, the Government our client. We agree what improvements are needed and Macmillan funds up front, our funding to be replaced once the pump is primed and the service starts to deliver.

There is still plenty wrong with cancer care - if there wasn't, we wouldn't need to make the grants. We have no statutory funding, so we could let rip about the underfunding of palliative care, the outrageous waits for radiotherapy and so on.

Why don't we? Often because we want to work with the very people we would be tearing into. Running down radiotherapy while telling the Macmillan radiographers how much they matter wouldn't sound very convincing.

And if you shout about everything, people cover their ears. The founder of Macmillan was a savage pamphleteer in the 1930s and 1940s, lacerating the health establishment for its neglect of the scourge of cancer. But his vision was achieved only after his death. Now we use the whole campaigning menu: research, information, education, funding, publishing, the media, lobbying. We're publicly critical where it's the best approach, always in combination with other methods. Are we muzzled?

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