Examination of Witnesses (Questions 20
- 39)
THURSDAY 7 JUNE 2007
LORD ADEBOWALE
AND MS
JOYCE MOSELEY
Q20 Julie Morgan: I suppose
you could say the public sector are more directly accountable
to the public in a democracy, as you were saying earlier on. How
do you see your accountability?
Lord Adebowale: I think we are
incredibly accountable, actually. There is a slight difference
in my response to that point in that we are regulated by the Healthcare
Commission, the Commission for Social Care Inspection, the Housing
Corporation, the Audit Commission and the Charity Commission,
which I think is enough to be going along with, but we also have
the scrutiny of our contract commissioners in several hundred
different locations to contend with, so I think the regulatory
aspect of accountability is very clear and something we take very
seriously, and, frankly, we would be out of business if we did
not. In the more general sense we are a very transparent organisation.
I think people see what we do. Because we campaign publicly people
can critique us publicly, and often do. I think that creates a
different level of accountability which I guess is very modern
in these days of public accountability through the media. I do
not shy away from it. I do not think it stops us from being effective.
Ms Moseley: Could I add to that
point because I think there is another dimension and I am confident
that Victor would agree with it, which is the accountability to
our beneficiaries, to our young people, and the accountability
to our mission and what our charitable objectives are. Something
that I always ensure I ask our front-line staff and volunteers
when I go and visit our services is, "Are you delivering
a service to these young people which you feel is of good quality,
is meeting their needs and is what you think these young people
need?", and if there is huge doubt about that then I would
want my operational staff to be questioning why we are in that
contract. We will also, of course, turn down and not go for a
contract if we do not believe it can be delivered to the quality
that we are prepared to deliver at, so there is that other level
of accountability.
Q21 Paul Flynn: It is very
good to hear that you are not inhibited in your campaigning by
having the burden of being caught in possession of intelligent
ideas. You had the campaign on crack, you had the campaign on
trying to emphasise that the Government's use of the criminal
justice system is not helpful and that they should be choosing
more the health and social care outcomes. We are coming up to
the 10-year review of the 1998 strategy. What will you be saying
to Government about what they should do?
Lord Adebowale: The drug strategy?
Paul Flynn: The Government strategy which
started in 1998 is going to be reviewed; it is a 10-year strategy.
Lord Adebowale: That is the drug
strategy?
Paul Flynn: The drug strategy.
Lord Adebowale: There are so many.
Paul Flynn: Indeed, absolutely.
Lord Adebowale: I think we will
be saying the following, first that this Government's attention
on getting more people into treatment has been very useful and
very effective and it is something that we have campaigned for
since well before I arrived at Turning Point. We have consistently
said that treatment is the most effective way of managing the
substance misuse challenge in this country—and, by the way,
when I talk about substance misuse I refer to alcohol and other
drugs. The Government has gone a long way in increasing the resources
and the attention. We will say that the criminal justice slant
on much of the Government's policy on drug misuse, while being
useful in one way in that it has released resources and has certainly
focused on the nuisance element, needs also to focus on prevention,
ie, those people that are at risk of taking substances in a way
that will be of harm to themselves and others and need access
to treatment in ways other than through the criminal justice system.
We will also point out that the issue of dual diagnosis, ie, that
there are significant numbers of people with mental health challenges,
and some put it as high as 60 %, who are also self-medicating
or taking substances both legal and illegal, needs to be thought
through. There are few services that are able to deal with that
dual diagnosis and in a sense, unless we can deal with that challenge,
there is a real danger of the inverse care law hitting those people
hard and costing public services more money. Those are the kinds
of things that we will be saying by way of assisting the next
drug strategy and those things will be based on sound research
and experience of delivering drug services to 70,000-odd people.
Q22 Paul Flynn: You suggested
that you have a better way of dealing with crack. What is it and
what hopes do you have of the Government adopting it?
Lord Adebowale: The report you
are referring to is a report on crack that we did about two years
ago, the elements of which were that there was a need for more
crack services, that there was tending to be a bias towards opiate
services and not stimulant services generally, crack being a stimulant,
that there was evidence that crack was being taken with heroin
in a practice known as speedballing, and that services needed
to be aware and more research needed to be done on that kind of
poly-drug misuse, and also that more research needed to be funded
to look at more effective methods of working with crack users.[3]
We have also used some of the research from The Crack Report
in The Sharp End Report which I referred to earlier in
that it is also clear that injecting drug-users have also started
to inject, and again this is something not just familiar to Turning
Point, but also to Joyce's organisation, to Rainer, where you
have drug-users who are using heroin and crack, an injecting drug
which will do two things. One, it will rot your veins and your
arteries very quickly and, two, it increases the chances of blood-borne
viruses and illnesses. The increasing use of that kind of drug
needs a different kind of service response, what we are arguing
for. We know that this Government has a real problem with safe
injecting rooms, despite the worldwide evidence that they reduce
nuisance and increase health outcomes for drug-users and we will
campaign until the Government listens, so that is the kind of
thing that we say in those reports.
Q23 Paul Flynn: Is there a
sense of frustration for you and your charity, perhaps both charities,
and you say it in your report in this area as well, that you are
working within straitjackets where perhaps, if you were operating
as a charity in other parts of Europe, you would not have the
problems you have? You have already reached the higher echelons
of the House of Lords and, if you had control of the whole system,
you would move into 10 Downing Street, which would be a great
move, but, if you had the power to change the system, what system
would we have?
Lord Adebowale: I never confuse
access with influence. I personally, if I may speak personally
for a second, remain both an optimistic person, but also yes,
I am frustrated. Every time I go to an area, which I have been
doing for the last 30 years, I guess, where public money is being
spent to little effect, I know that not just Turning Point, although
I will speak for Turning Point, but also Joyce runs an excellent
organisation which could be providing services better or providing
a service to these people. I am frustrated that the Government
does not always take on board, and engage with, the opportunities
to deliver services that we know will work for people who are
marginalised and I think it is frustrating that the Government
has not engaged with the idea of safe injecting rooms. I think
it is frustrating that, although we have had a lot of support
for our Connected Care service, what we want is a partnership
with a government that, how can I put it, is willing to invest
with us in mainstreaming services and service approaches that
we know, because we have done the work, will work. If you look
at the history of the third sector, you will see the start of
many things that the public now take for granted, such as social
housing, the Health Service actually and the Probation Service,
and what I am suggesting and what frustrates me is that, given
that is the case and given that we have more sophisticated methodologies
now of assessing need, that cycle could be faster, I guess, and
we could be working more in partnership. As I say, it is not either/or,
it is and/and, so that frustrates me, yes.
Q24 Paul Flynn: Joyce Moseley,
I do not think you operate in Wales, as far as I know. Do you?
Do you operate to a large extent in Wales?
Ms Moseley: We are just starting
to and Communities that Care, a small organisation, we now house
them, they have become a part of us, but they still retain—
Q25 Paul Flynn: It is about
time since you have been going since the 1800s!
Ms Moseley: 1788.
Q26 Paul Flynn: Well, there
is a certain lack of ambition there if you are just getting into
Wales now! You tell the story, which is obviously important to
you, of what happened in the mid-1800s when the Government and
Newgate Jail wanted to pass on some of the young offenders and
you made the point of saying, "Well, we'll accept them, but
only if it is within the spirit and the tradition of our organisation".
How much are these remarkable results that you have down to the
fact that you are picky about the people you take? Are you selective
in the number of people you take, please do not be offended by
this, because it does seem extraordinary high, the record of achievement
that you have?
Ms Moseley: If we have got the
contract to deliver, say, bail and remand services, for instance,
there is no picking and choosing at all; you take what the court
is working with.
Q27 Paul Flynn: Well, why
do you make that point? What is so special about the Rainer tradition?
Ms Moseley: If I can finish, what
we will be picky about is whether we go for that contract or not
and, as I said before, whether we are prepared to work in the
way that some contract is set up. I want to add a bit to the previous
question about the frustration. I think that the concern I have
is that the good ideas that are around at government level, policy
level and the difficulty of getting those translated into practice
on the ground, that delivery chain is too difficult and there
are too many hurdles, and I go back to your example. I know that
Victor's organisation and mine together would love to provide
criminal justice drug services to a whole community and really
work with community groups and so on, and we know that could work
and we have got evidence from other parts of the world. We cannot
do it because nobody at the commissioning level is thinking in
those ways, so there is something about those good ideas being
translated into mechanisms to get it to happen which is what I
am frustrated by.
Q28 Paul Flynn: You quoted
an example, an initiative by the charities which was taken up
nationally, and it was needle exchanges. That happened under the
Tories, so it was a long time ago. You take a large campaigning
role as well, and Turning Point probably does, but are there other
issues you would like to see changed?
Ms Moseley: The two things certainly
I would quote more recently are bail and remand for young offenders
and care-leaving. Rainer, when it was known then as the Royal
Philanthropic Society, did start those two services and campaigned
to get them to begin statutory responsibilities and those have
been very recent changes and we can show the direct relationship
between what we innovated and then what became a public service
as well as the Probation Service which, people have recorded,
we started back in the 1870s. What we would like to see change
now, well, certainly if I look at young offenders, I think the
26 % increase in the number of young offenders who have been brought
into the criminal justice system in the last few years is an unnecessary
waste of public money as well as an ineffective way of dealing
with young people who are at the very early stages and is often
as a result of unanticipated consequences of other things. If
you take the police target to increase their rate of bringing
people to justice, you can see a direct relationship with that
target and the number of young people being brought into the criminal
justice system. Therefore, if I was criticising the Government,
which I have, I have been on the Youth Justice Board and been
very involved in those deliberations, the increased criminalisation
of young people and the increase of custody for those young people
just does not work and it is not having an effect on the young
people in those communities.
Lord Adebowale: With reference
to the issue that you are most interested in, I think, which is
the third sector, the one thing that needs to change really is
the commissioning.
Ms Moseley: Absolutely.
Lord Adebowale: It needs to change
in the following ways: first of all, the Government needs to define
clearly what it is, and the one thing I know about large, complex
systems is that you need to define what is important; we then
need that definition to be applied ruthlessly and the mechanisms
of commissioning, in my view, need to be defined; and the commissioners
need to be held accountable for commissioning outcomes.
Q29 Paul Flynn: Your memorandum
lays stress on the amount of energy, time and research that goes
into it, huge amounts of your time spent doing a job you should
not be doing, preparing to win contracts. This really is an awful
waste of your time.
Lord Adebowale: I think poor commissioning
leads to poor procurement and poor procurement leads to poor contracting.
A lot of the commissioning or so-called commissioning that both
Turning Point and Rainer are subject to is not commissioning,
it is purchasing and purchasing based on price, not on value or
on any other kind of analysis. I am not blaming because I think
many local commissioners are up against it and they feel the need
for it to be a price-based purchasing model, but I think governments
need to be really clear about the commissioning issue because
that is the thing that defines how public money gets spent and
what it gets spent on and, until we get to grips with that, I
think we will be wasting it across the piece.
Ms Moseley: That sort of commissioning
and contracting means you do not get out of us what potentially
you can get which is the innovation, the different ways and the
transforming of services rather than just transferring out in
the same vein because there is no, if you like, `wriggle room'
within a contract for us to try out and experiment, and that is
a real loss for everyone and a waste of public money, in my view.
Q30 Paul Flynn: Can I make
a final point which does not apply to your organisation, which
I think we both regard as being a splendid organisation in every
way, but, as a general rule, criticism of the nature of charities
is that charities have a vested interest in continuing the problem
they are dealing with and expanding their area of work, whereas
statutory bodies have a vested interest in diminishing the problem.
The example, I will give just a brief one, is homelessness and
rough sleepers. We know there has been a reduction in rough sleepers
in this city to about a third of what it was and everybody would
agree with that, but there has not been a diminution in the activity
of the charities looking forward; in fact there has been an expansion
and they have been empire-building in those areas. Is this not
the nature of the third sector, that they do have that vested
interest in expanding, exaggerating and continuing the problem
they deal with?
Lord Adebowale: I cannot really
speak for, and I think it is important that I do not pretend to
speak for, the third sector, but what I can say for my own organisation,
sadly, is that I do not believe we will ever be short of work.
We have doubled in size and the numbers of people that we see
have continued to increase year on year. I think the nature of
the challenge changes and, therefore, the nature of the organisations
that are dealing with one challenge changes and, in that sense,
the organisations in the third sector are no different from organisations
in the private sector. If the market shifts and the needs of the
market shift, organisations will look at the services they provide
and look to change them. Now, I do not see there is anything wrong
with that and the example that you have given is something I know
something about, having been the Chief Executive of Centrepoint.
We campaigned very, very hard to end youth homelessness and to
certainly end the sort of homelessness you are referring to on
the street. When the Government invested in the targets to reduce
street homelessness, we supported that and, alongside a lot of
other organisations, put services in place to achieve that target.
However, simply because we have taken people off the street does
not mean that those people cease to be vulnerable or cease to
be in need of support in their own homes, and I am speaking theoretically
and I am going beyond, I guess, my brief here, but your question
is an interesting one. What it boils down to is that, if an organisation
sees that there is a need for end services in a transformed market
because things have changed, I personally see no reason why it
should not change its service offering to meet that need. I do
not think that is the same and I am sure that you would find it
appropriate to express alarm at the thought that any organisation
in my sector was seeking to generate a social challenge, and I
think it is a rather cynical comment and it is not one that applies
to organisations in other sectors. My organisation would be more
than happy to see the end of substance misuse as a social challenge
in this country, but the reality is that it is unlikely and the
kind of society in which we live means that there will always
be people who have those challenges and require an appropriate
level of support, and my organisation is ready to hear from them,
as we are from people with mental health problems and learning
disabilities, of which there are 1.5 million people in this country.
Ms Moseley: I will perhaps go
a bit further than Victor and say that I do have concerns that
sometimes there are too many charities and that there is an element
of the survival instinct which takes over sometimes. Speaking
for Rainer, we have a clear statement of intent by trustees that,
if it looks as though it will improve services for young people,
we will discuss with any other organisations the idea of mergers
and alliances and working together to try and reduce the sorts
of things you are talking about. As an instance that I know about,
I thought it was sad, but very brave, decision, for instance,
of the Family Service Unit, the FSU, to join with the Family Welfare
Association and that is painful because of histories and so on,
but, having made that decision, what they have created is a very
strong organisation for families, so I do not think we have the
right just to exist because we exist and I think we should, as
trustees of organisations, always be having that as a question
in our minds.
Lord Adebowale: I absolutely agree
with that and I would give the example of a service that Turning
Point used to provide, a significant service actually in London,
which was HIV services in the 1980s when there was an increased
level of funding and for the statutory sector there was a different
type of response. We looked at our core skills and we decided
not to continue providing those services and we do not now. Some
would argue that that was premature, but that is a decision we
took and we will continue to stand by. I agree that no organisation
in the public sector, third sector or the private has the right
to exist simply because you exist and I think we would all agree
with that.
Q31 David Heyes: I want to
continue with this core issue, I think, about the problems of
poor commissioning and perhaps try and tease out of you some of
the ideas you have got and some of the thoughts you have got on
how that needs to be addressed, but I will just preface it with
a comment from my own experience. The last respectable job I had
before I became an MP was as a CAB[4]
manager and my recollection of that—I am going back six
or seven years ago now—is that maybe more than half of my
time as the leader of that organisation went into dealing with
issues about bidding for contracts, the monitoring process on
contracts and dealing with all those kinds of very complex issues
which, in an ideal world, I would have liked to have delegated
to somebody within the organisation, a kind of contracts management.
Of course the resources were never available for that because
you could never get full costs recovery or it was always difficult
to get that and it was very difficult, almost impossible, to generate
the surplus that would be needed to fund that kind of back-up,
so I am very familiar with the kinds of problems you are talking
of. I think it would be helpful to the Committee to get some more
of your thoughts on the record about the problems first before
we maybe turn, as a second question, to the potential solutions.
Ms Moseley: If you take the commissioning
process, it is made up of whole different sections; I think that
has to be part of the clarity of definition that Victor referred
to. I think it has to start, and this, I do believe, is the democratic
responsibility of, say, local authorities or the Government to
assess the needs of their local area, but that has to be done
on what I term `intelligence-led commissioning'. You need to look
at the data, you need to be talking to the people providing services
to get ideas, you need to be looking at your resources, et cetera.
Those are the people who actually need to know something about,
if it is young people in our case, their needs and they need to
understand the risks they face, the risk and protective factors
around them and so on; they need to be in some ways experts. What
happens at the moment is that that process gets, if you like,
contracted into a shortened version where procurement professionals,
the ones with the legalese, contracting bit, are leading that
process rather than being the next stage at the point where those
commissioners with knowledge are deciding the sorts of services
and the sorts of outcomes they want to achieve. I also think there
needs to be the ability to enter into a preferred provider status
at some point so that we are experts in providing services and
that expertise needs to be listened to and needs to be discussed
with commissioners so that there is an agreement reached about
the outcomes and how those outcomes are reached. I think when
it comes to the contracting, and Victor has already mentioned
it, longer-term contracting, contracting which is about outcomes,
clear responsibilities around monitoring and what results are
required and clear outcomes about shared problem-solving. Often
very unforeseen things happen with the sorts of client groups
we are talking about and something might happen in that local
community, more drug-dealers will come in and change the nature
of the offending patterns of young people, for instance, so you
need to be able to be fleet of foot and discuss those with your
commissioners at a point rather than a rigid approach to the contract
you have which allows no room to respond and work flexibly with
what is happening.
Q32 Chairman: Is there something
about EU procurement rules which makes intelligent commissioning
more difficult than it ought to be?
Ms Moseley: No, I think EU procurement
rules are often something of a smokescreen.
Lord Adebowale: I have been involved
in a number of attempts by the Government to define `commissioning'
in a way that is helpful to both them and us, not just the third
sector actually, but I think the private sector, as I have said.
Ms Moseley: The CBI have done
quite a good paper on it.
Lord Adebowale: The CBI, yes,
so it is not just the third sector, but commissioning, as I understand
it, is the means by which you understand and manage the marketplace
in the interests of providing a service for individuals and their
communities, and it should provide a platform for procurement.
It is not the same thing as procurement, and this is the point
about the European rules. I could give examples of commissioners
who have refused to talk to us because they consider it to be
commercially sensitive and you think, "Well, actually we
are the very people you should be talking to", commissioners
who go fishing for it and put us through a massive process of
questions and information and then basically take the information
and give the contract to someone that was already providing it,
and I am sure you are familiar with that one, commissioners that
commission on the basis—and they call it `commissioning',
but it is not commissioning—of a year's contract and you
have a chat with the commissioner and you say, "This problem
has arisen", and the commissioner personally says, "Well,
I don't like that client group. If you work with that client group,
we will end the contract", and we say, "Well, there
is a need in that particular market and in that particular area
of service", and they say, "Well, if you do that, we
will end the contract", so we go ahead and do it and the
contract is ended. Therefore, commissioning which is not commissioning
is expensive because every time you end the contract you have
to go through the whole process again and sometimes it happens
on an annual basis and it is the money wasted in that process
and the bureaucracy of it, so there is a real problem, as you
know. As you may be aware, the NCVO[5]
tended to focus on the contracting end through the Compact and,
I have to say, I do not want to speak for anyone else, but my
personal view is that the Compact is still giving birth to the
kind of vision the NCVO would like and I have yet to have a manager
come to me and say that the Compact has been on the table when
there has been discussion with commissioners as commissioners
tend to be non-commissioners and tend to be focused on the price.
Those are the kinds of problems that we are seeing which, and
I am speaking for Turning Point, in virtually every case result
in wasted money, wasted public taxpayers' money and possibly poorer
services than non-commissioning. Of course, if you repeat that
several hundred thousand times, you are looking at a lot of waste
and I think that issue does not just apply to the third sector,
but I think it applies to the private and public sectors as well,
to be honest.
Q33 David Heyes: I think we
need to move on to ideas about ways of resolving that. You both
kind of make the exhortation that the Government, local authorities
should do something about it, yet the context is a great imbalance
of power, is it not? I guess, Joyce, as a Director of Social Services,
you have hugely more resources. You are sat on top of a much bigger
budget than you do as head of one of the largest voluntary organisations,
that is true, and any local primary care trust or local authority,
any single one of them is going to be massively bigger than the
biggest voluntary sector organisation, so there is this huge imbalance
of power there and it is not sufficient, therefore, to just exhort
them to change their ways. How do you get them to do that?
Lord Adebowale: There are some
things that I think we need to do. First of all, as I have already
said, the commissioning needs to be defined. I think it is one
of the things over the next five to ten years that the Government,
no matter who is in power, will need to get a grip on as a key
way of doing business as the Government moves much more into the
commissioning of services rather than the provision of them. That
is not a statement of preference, it is just the way it is. Commissioning
is going to become very important, I think, to define it and as
the skill of doing it, and that is what needs to be done. I think
that the regulation or the regulatory environment needs to hold
commissioners accountable for the outcomes of their commissioning
practice, so, if you go to an area where a particular community
has not got a service, literally has not got a service, and you
say to the commissioner, "Why is that?", and they say,
"Well, we haven't got enough money", I think the question
ought to be asked, "Can you audit-trail your commissioning
process? Show me how you arrived at this situation", because
sometimes it is not about the money, it is about how the money
was spent which starts with commissioning. So there is a question
of accountability for commissioning outcomes which I think regulators
need to take on board which they are not doing sufficiently, in
my view. If they did so, then commissioners would have to engage
with the market in a clearer way. On the contracting issue, certainly
in social care, and it is something that Turning Point has done
a lot of work on, in the building business, if you are going to
commit a lot of taxpayers' money to a building, you have to use
a JCT[6]
contract, a standard form of contract which has clauses in it,
which is appropriate to the size of the contract and which is
clear as to where the risk is and it is not loaded on one side
or another. However, in social care it is still the case in too
many instances where contracts, as Joyce has pointed out, are
often loaded in such a way that we take all the risk, there is
no risk taken by the purchaser of that service or they are not
really getting the value out of that contract they should be doing,
it is unclear and basically the lawyers might benefit down the
road, but certainly the client does not. What I have been arguing
for is better standardisation of contracting across the piece
which I think we could do with, certainly in social care. Those
are some of the things that I think would help in getting to grips
with both commissioning and contracting. Procurement has been
the detail and I would leave procurement alone. There are files
and files on procurement practice, some of it coming from the
EU, and I think less is more in that case, but I think that commissioning
and contracting need some attention.
Ms Moseley: I would add a couple
of things to that. At the moment, the Government is putting some
money into training 2,000 commissioners across the country. Now,
if those commissioners, say, from local authorities are trained
on their own, we will be back to the same thing. We ought to be
being trained and discussing what `commissioning' means across
sectors so that actually there is an opportunity to understand
each other's drivers. I go back to what I said, that local authorities
do not know how to buy and we do not know how to sell. We actually
need to understand where each other is coming from so that we
can both contribute to a better commissioning process, so I think
there is something there about making discussion and training
open across the sectors. I think the other key driver we have
to change, and it is probably the only driver now, I look back
with rose-coloured spectacles to the Community Care Act when I
was told, "You have to spend 83 % of your money in the independent
sector", and that was a huge watershed and a big change for
the voluntary sector and the private sector obviously. That is
not going to happen. I am sure no government is going to come
in and say where public money has to be spent by whom, at the
local level. The only driver there is is through the various inspection
regimes on public bodies and at the moment there are no aspects
of that which encourage. It is starting to happen, but there is
little which is in there which will encourage good, creative commissioning
processes and that, I think, will be across the whole lot, whether
it is Ofsted, whether it is the joint area reviews, whether it
is through supporting people, housing and so on. I think there
is something there which could be cross-government so that you
have actually got some consistency about what is being looked
at; back to Victor's definitions issue.
Lord Adebowale: Mr Heyes, your
point about the power thing is very important in relation to what
Joyce has just said because in the health sector, for instance,
where you are getting an increasing number of foundation trusts,
the theory is that they will compete in a mixed economy. However,
there is an experience I fear, which has happened in other places,
where actually what you get is a kind of false economy, a false
market in which the foundation trusts are supposed to be independent
but also have a relationship to the commissioners that they have
known and have historical relationships with. Basically, they
want to keep their market size, their market share, and they are
in cahoots, for want of a better term, with commissioners against
any other interlopers, as they are seen, into those markets. Therefore,
whilst it is not public or it is not known, suddenly you find
that these contracts that come up for tender are all being won
by former trusts that are now foundation trusts in exactly the
same way as they were before because nobody is questioning that
and nobody is saying, "What was the commissioning framework?
What was the procurement process? How were these contracts designed?"
I think that is something that the Government needs to pay attention
to because there is no point in having a mixed economy if it is
skewed.
Ms Moseley: Or if there is not
political leadership at the local level to say that actually it
is something they want to see, and I think there is still discussion
to be had there.
Q34 David Heyes: Ironically,
I found myself in a position locally, as an MP, of being asked
by voluntary organisations to intervene as advocate and make the
case against the local authority for the unfair pressure and the
unreasonable expectations that were being placed on the voluntary
sector.
Lord Adebowale: In a sense, if
the commissioning is right and the procurement platform is right,
then it should be transparent and everybody would see that and
there would be no need for a special plea because everybody would
know what the score is.
Q35 Chairman: When you talk
about more accountability for creative commissioning, do you really
mean that that should be done by the regulator, by the inspector?
Is that the mechanism?
Ms Moseley: I think they should
be regulated and inspected on.
Lord Adebowale: I am with Joyce
on that. At the end of the day, given the ecology of regulation
that we have, if X amount of money has been spent, the basis of
that expenditure surely must be accountable to someone. If there
is a section of the community that is getting a poor service or
no service, it seems to me that either that section of the community
should be able to complain or make a case that says, "Well,
how come X amount of money was spent in this way and we're still
without a service or with a poor service?" The commissioner
should have to account for the process that was gone through in
order to provide the procurement platform that procured the services
that are now in place, "Can you audit trail? What methodologies
did you use?" One of the things our organisation has been
pushing through the Connected Care process is the methodologies,
the actual techniques that commissioners use to engage with the
communities, who often are surprised by the approach which again
is odd, in getting them to help design the services that they
will use, and it is getting those techniques applied by commissioners
consistently and holding them accountable to it which I think
will change the commissioning landscape alongside, as Joyce has
said, increasing the professionalism of that particular skill
and I think, until we do that, it is going to be hit and miss.
Q36 Chairman: Yes, I understand
the argument. I just wanted to ask you more precisely, who do
you think is probably going to hold commissioners to account?
Lord Adebowale: You have got the
Audit Commission. There are a number of bodies and I think each
could have a role in the regulatory framework. I am not qualified
to go into the detail of their statutes, but it seems to me that
it is not unreasonable to be looking to the Audit Commission,
the Healthcare Commission and others and to say, "Can you
look at the commissioning framework?"
Ms Moseley: I think it is something
that certainly the new Chair of the Audit Commission, who I know
was personally very involved in the development of commissioning
around the Community Care Act, would be interested to see. I think
it would also be interesting to look, and my instinct says you
will find something, at good services out there as defined by
things like Ofsted and joint area reviews, is there a correlation
with the extent of working within a social market of those authorities
or, the other way round? If you come across authorities where
services are defined as poor, can you see that actually they failed
to look outside of themselves into a social market to help improve
the services for their residents and their communities.
Q37 Kelvin Hopkins: Your strength
has been, and your role in the past has been, providing for niche
sectors, largely for the excluded minorities, not the included
majority—that space between the provision of absolutely
vital social services, education, health, police and where there
was maybe no provision in the past. So you have not concentrated
on universality or equity, but you have just been dealing with
problems as you found them and provided for people who, if they
were not provided for, society would not really bother about very
much. With drug addicts dying, we would still function, but we
could not function without education or without a broad health
service. Do you think there is a natural boundary between what
the third sector should do, your sector, and what should be statutory
provision because the reason you are here and the reason why we
are doing this inquiry is that the Government is now pressing
for your sector to take on a wider role and to take over what
in the past would have been regarded as more statutory, general
provision? Is there a natural boundary and are you reluctant to
move in that direction?
Ms Moseley: If you take universal
services, my view is that you cannot see the sorts of services
we deliver outside of the concept of the universal services. I
think if you take, say, care leavers where there is a responsibility
on the State because they have often taken over the parental role,
or young offenders may be a better example, if you are not actually
putting intensive services in there to change their way of behaving,
the whole of that community, the universal, suffers for that,
so I do not see a separation out, but it has to be looked at as
the whole and we have to strengthen universal services, for instance
the education service, when it comes to young offenders much more
at that universal level, the school level, in order to continue
to offer a service to young offenders because we know that a lack
of education is so correlated to offending rates. I would want
to see our services to young offenders working absolutely in partnership
with the universal education service because that is how you are
going to get the best results for the individual young people,
but stopping them offending is surely a benefit to us all. When
you said that nobody cares about the drug addict dying, they certainly
complain about the number of offences and housebreaking because
of the way we do not deal with the addiction problems that are
there. I do not know whether I have quite answered your question.
Lord Adebowale: Putting it another
way, I think it is a very interesting question and it gets to
the heart of the issue. It is interesting that nobody really asks
the question of the private sector, whether there are any areas
in which the private sector should not be providing a service
or indeed the public sector. No one has really debated that issue.
I know there have been people who think certain things, but it
has never really been encapsulated in a debate. I would say two
things. We provide a drug service in Central London and I am pretty
certain that, if that service were to close today, or I can guarantee
actually, you would notice the difference by Monday morning as
you walked through the West End. Now, it is funded by the taxpayer
through one means or another. Is that a public service? I think
the people walking through Soho on Monday morning would probably
argue that it was. The fact that it is provided by a third sector
organisation, no. We provide the service and I think it is very
much a public service as opposed to a luxury which could affordably
not to be provided, say, if people did not put their hands in
their pockets and fund us. If someone were to have said to me
a few years ago, "Should you be providing this service? Should
it not be provided by the local authority or the local health
authority?", I would have said, "Well, if the local
health authority can come up with a value-based proposition that
the commissioners, whoever they are, are willing to buy, fair
enough". However, if we can come up with a service which
keeps those substance mis-users out of nuisance and stops them
from dying, because of course people dying on the streets, I agree
with you, certainly some men or women on the Clapham omnibus would
say, "I don't care", but they would care if they saw
the body and they would certainly care when they saw the bill
to the NHS, so I think we are providing very much a public service
and I do not really have a wall that says, "This far and
no further" because I do not think we provide a luxury service
to society. I do not think we provide add-ons where it does not
matter if it goes bust or goes under because I think it would
matter and I think it would matter a lot. We provide the service
to one in 400 of the British population and I think that, if those
services were to be withdrawn, you would notice the difference.
Q38 Kelvin Hopkins: I am putting
my thoughts into a somewhat cynical question. I agree that the
work you do is absolutely immensely valuable and I am not in any
way decrying it. What I am trying to get at, and you made the
point earlier, is that much of what we have now as statutory provision
started as voluntary sector organisations—education—churches
started to educate people in Scotland and it developed from there.
Health was provided by voluntary organisations and it gradually
progressed towards being statutory, state provision. Is what the
State is now suggesting a move in the other direction, moving
what is now statutory into the third sector? Is this the Government's
objective, rather than reaching out to people perhaps even now
who are not being reached and providing more of the kinds of things
that you do and I think would be immensely valuable? Our surgeries
are full of people who need services such as this.
Lord Adebowale: I will tell you
what I think is unhelpful in this debate; it is talk of takeover.
I am not interested in taking over public services in the sense
that will not bid. We are very clear about it. I do not want to
provide services to people with, say, learning disabilities cheaper
than the public sector, but to the same standard as the worst
provider in the public sector or the private sector. In other
words, if somebody says to me, "Can you replace a public
sector service cheaper?", I will say, "Well, I want
to provide a better service", let us be clear about that.
I am not interested in takeover, I am interested in partnership.
I can understand people in the public sector services who are
working and have got families and hearing that they are going
to be taken over. It sounds like, a loss of jobs, reduced rights,
et cetera. I have to say, Turning Point's and indeed, if I may
say so, Rainer's terms and conditions for our staff are strong
and certainly would compare with any public service and long may
it continue because I think our staff deserve it. I want to work
alongside public services and I think we do on many occasions
and I will also work alongside private sector services in the
interests of, as I say, Turning Point's mission and our service
expertise. In doing that, I do not see that there are areas of
no-go, providing that it is adding value, not just replacing cheap
with cheaper. I personally and my organisation just are not interested
in doing that and we are not interested in takeover talk either.
Ms Moseley: Whilst we do that
sort of work and will be delivering services to the public, that
does not stop, and should never stop, the emergence of other organisations
or us doing it for a need that becomes apparent. I think what
we probably do is innovate in the way services are delivered to
a known group, young offenders or whatever. You were talking about
the Damilola Taylor Trust or the Suzi Lamplugh Trust, fantastic,
they come together around a particular issue, around something
and start to highlight things and I do not see why that should
ever stop because third sector organisations take on, and start
delivering, more of the services to the public.
Q39 Kelvin Hopkins: If I could
approach it another way, all of this has been driven by an ideology
coming from our political leaders that they want to reduce the
role of the State. They want to dismantle it and load its responsibilities
on to others with private sector commissioning, the Nicholas Ridley
agenda, which was to get rid of local authority provision of direct
employment entirely and farm everything out to private contracts.
Now, is the third sector being used to an extent as one possible
way of unloading what is now statutory, state provision, on to
another sector. And is there a danger that organisations like
yours could become companies over time and could become more like
the private sector, operating on a contract basis but doing essential
public services?
Ms Moseley: But there is another
way of looking at it which perhaps my over-enthusiastic optimism
is responsible for, which is actually that looking at a social
market is about improving the quality of services. I think whilst
we move into a social market in terms of provision, what I would
want to see—this goes back to the discussion on commissioning—is
a much strengthened role for those local, democratic, public services
which is about being held to account for what they are delivering
to their local population and how they are communicating and defining
those issues with their local population. Honestly, as a Director
of Social Services, I could not understand why we were delivering
inhouse all the services we were delivering. They were not done
well and others could do them better. However, I maintained or
felt I had the absolute responsibility with the local politicians
and Members to say, "Let's understand the needs of our community
and what it is that we ought to be providing here", and this
was in an inner London borough, so we knew we needed particular
types of services which an outer London borough would not need,
and we were responsible for that. Who provided it was not the
issue and that did not diminish, in my view, the responsibility
of that local, public service.
3 Turning Point, The Crack Report, July 2005 Back
4
Citizens Advice Bureau. Back
5
National Council for Voluntary Organisations. Back
6
Joint Contracts Tribunal. Back
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