the hsj interview: Victor Adebowale

Published: 03/06/2004, Volume II4, No. 5908 Page 24 25

People's peer Lord Adebowale believes the marginalised in society are still ill-served by the statutory sector. He says it is time the NHS overcame its prejudices and started to build a meaningful relationship with the voluntary sector

Cinderella needs a new fairy godmother - the old one just is not delivering. Or at least that is the view of Victor Adebowale, people's peer and chief executive of social care charity Turning Point.

He is one of the most highprofile voices calling for the statutory sector to revolutionise the way in which the so-called Cinderella services like mental health, substance abuse and other community-based care are provided through a huge increase in the role of the voluntary sector.

He believes it is the only realistic way to replenish the welfare state: 'I could take someone by the hand and go to some estates in Britain where, if you did not know, you would think the welfare state did not exist.'

Turning Point, which Lord Adebowale has revitalised since he joined three years ago, is a good example of that replenishment, providing complex needs services on 35 of the country's worst 88 estates. But he believes this is only nibbling at the edges of the problem of social exclusion and is lukewarm on the government's record over the past seven years (praise for Sure Start not withstanding).

'We are scraping the surface when what we need is a vision on the scale of [welfare state 'architect' Sir William] Beveridge. We need a fundamental shift in the way public services are delivered.'

He says social care is a victim of the 'inverse care law': the people who are most in need of the service are the hardest to reach and therefore benefit least. And as with chronic disease, a relatively small percentage of the population with multiple problems will account for a high proportion of total costs to society. He believes the voluntary sector has the existing community links, the expertise and the energy to provide a bespoke service.

It is the tailoring that is important. Lord Adebowale believes much social care suffers from small, short-term projects that pretend all poor communities are poor in the same way.

Earlier this year the charity put out a paper with thinktank the Institute for Public Policy Research calling for 'connected care centres' - facilities embedded in a particular estate's needs.

He says it is based on lessons learned from traditional regeneration: 'You do not regenerate the buildings until you regenerate the people. They shouldn't spend a penny on these estates until three things happen. First, a real picture is created of people's experiences and what they need. Second, you design a set of services that both provides social care and is a gateway into the rest of the system.

Third, you get funding that will not disappear after a few years. It needs to exist as long as social services exists.'

Although some commentators believe that community fragmentation will be a big issue in next year's general election, Lord Adebowale is pessimistic.

He is angry that mental health is increasingly dominated by the Home Office model - based on criminal justice, rather than health and treatment.

'That will be seen as vote winner by some politicians, and that would be a huge mistake. Once you have turned this into a criminal issue, It is very hard to get the public to think about treatment.'

But he says his 'people's peer postbag' tells him 'the public know when they are being conned'.

'Certainly in black communities they want to see political leadership that doesn't fob them off.'

He blames the Home Office dominance of the agenda on a lack of leadership from other quarters. He is harsh about prime minister Tony Blair's recent contribution to the alcohol debate, 'talking as if it was only a problem because it caused crime - in fact the problem is that it costs the NHS£7bn a year'.

'I think it is outrageous that a prime minister can say binge drinking is the issue when I know and he knows that it is health.'

He is also critical of the absence of any major contribution on mental health from health secretary John Reid.

'Maybe his advisers tell him It is not a popular issue. I do not agree.'

He is mildly pleased with chancellor Gordon Brown's recent Futurebuilders initiative which provides£125m for statutory organisations to contract with the voluntary sector: 'It shows he knows we are about more than volunteering, but he should really be talking about£1.25bn.

'I've had chats with Gordon and will continue to do so until I see funding allocation heading in the right direction.'

Part of the problem is a hangover from Victorian philanthropy - the idea that fighting poverty is essentially a moral issue.Although Lord Adebowale clearly feels a personal moral imperative, he is canny enough to know how easily that is crushed under realpolitik.

'I want to see a shift in emphasis towards the business case - the fact that for every£1 you spend on treatment you save£3. Early intervention on anxiety saves five times as much on locking people up and drugs that do not work.'

His main hope lies in his idea of a 'voluntary finance initiative' (VFI) that he first floated at the 2001 Labour Party conference.

Basically It is the 'very straightforward idea' that would allow the statutory sector to buy large packages of provision from the voluntary sector in the same way as the private finance initiative with the private sector.

The three key elements are longterm contracts (not five years but 25 years), standard contracts and shared risk.

A commission set up by ACEVO, which represents voluntary sector chief executives, reports on VFI in September.

Lord Adebowale is optimistic, but anxious that the concept is not perceived as the voluntary sector looking for favours: 'The way the idea is presented is as important as the idea - so many voluntary sector ideas have floundered on the altar of special pleading. I do not want this one to go the same way.'

He also cautions that voluntary organisations have their own challenges, including becoming more collaborative: 'Competition in the voluntary sector is vicious - it knocks the private sector into a cocked hat; it can be damaging.'

VFI doesn't require any change in the rules. But it does require a leap of imagination: 'The blind spot needs to be removed.

'I talk to chief executives who are spending a fortune on out-of-area placements. If I had a long- term contract to deliver a service I could borrow against it, get capital to build a resource. And I do not have shareholders, I do not have to drive a Rolls Royce and I do not even have to own the equity.What a deal!

'Hundreds of millions of pounds are being spent on this because of a lack of understanding of the market and a lack of trust.'

He points to recent research by the National Institute of Mental Health on why health managers are reluctant to work with the voluntary sector: 'They do not think We have got clinical governance!

Actually the sector is awash with it - Turning Point operates under the Charity Commission, the Housing Corporation, local authority regulatory frameworks and on and on.'

He reserves real anger for the belief that the voluntary sector is a cheap option, allowing commissioners to tick the provision box without regard for quality: 'They end up paying twice as much for out-of-area placements.

'Turning Point has had situations where We have turned a service round, but the commissioners will not let us carry on unless we halve the price. I will not do it, so they go to the private sector who will always say yes - and the service reverts back to the old shocking standards.'

'I talk to primary care trust chairs who want to make change but, I suspect, feel hamstrung by internal bureaucracies.'

He says government 'needs to expect more from them, ' setting incentives to make VFI rewarding.

'We have gone too far now to go back to a belief that the only solution is a public solution. I believe I am a public servant and that I deliver public services. I think if you ask the people who use them they see them as accountable, public services. Let's avoid romance; It is about filling gaps. It has gone too far to go back to halcyon days when everyone was a public servant - it never happened.

If that worked, Turning Point wouldn't have needed setting up 40 years ago.'

Lord Adebowale will be speaking at the NHS Confederation conference on 23-25 June on 'Working together to reduce social exclusion', sharing the platform with Claire Tyler, director of the government's Social Exclusion Unit.