Lord Victor Adebowale is chief executive of learning
difficulties, mental health and substance misuse agency Turning
“The idea we should turn our backs on those who need a service
in order to maintain an idealogy of independence is not only
misguided but unpalatable”.
Not-for-profit agencies are at a crossroads. Taking one path would
see us delivering more social care services. The other path would
see us turning away from service delivery for fear it might somehow
compromise our independence.
I firmly favour the first path and this is not an argument from
ideology; there are simply too many people in need of support.
These are people from whom the private sector can’t turn a profit
and the public sector cannot reach. The third sector can provide
the only effective intervention and we have a duty to support
Those against a bigger role in service delivery argue that in
taking funding from government we limit our ability to campaign.
And, that by delivering such large-scale services we somehow morph
into another arm of government, losing the independence that makes
us effective. But the idea that we should turn our backs on those
who need a service in order to maintain an ideology of independence
is not only misguided but unpalatable.
Delivering services to the public is not the same as becoming a
public service. It is our sector’s values that make us so effective
and so trusted by service users, rather than size, structure or
funding streams. It is possible to maintain those values and the
focus of building services around the client no matter how big an
The point about campaigning is also wide of the mark. After all,
the private sector seems to have few qualms about lobbying
government at the same time as delivering services for them. And in
my time as chief executive of Turning Point, which receives 98 per
cent of its funding from government, we have campaigned on issues
from the closure of long-stay hospitals to the shortage of services
for crack users.
So why are these concerns so persistent? And why should they be
levelled at the not-for-profit sector but not the private sector?
The answer lies in the relationship between commissioner and
service provider. The approach from government to the private
sector is: “This is the service we need provided, how much will it
cost?” whereas the not-for-profit sector is faced with: “This is
the service we need provided, here’s the money we’re willing to
It is this unequal relationship that we should address rather than
the ideology of whether we should or shouldn’t be in the business
of public services. Because while we are busy arguing among
ourselves I can guarantee that the private sector will have
answered the government’s call and users will be even less likely
to get a service.
Meanwhile, the joint white paper on health and social care has
further fuelled the debate, leading to some polarised positions.
The fear here is that social care will get rolled over by health.
Yet for too long the two sectors have been poorly integrated and
this white paper gives us a real opportunity to give social care
its proper place in tackling a host of public challenges.
The government has started to acknowledge this, although it talks
in terms of the choice agenda. But what choice seems to mean when
you drill through the rhetoric is focusing services around the
needs of the user. Certainly John Reid, the previous health
secretary, talked about choice as a way of reshaping health
services according to people’s need, particularly those currently
missed out by the system. This sounds a lot like good social care
and I hope to hear more of it from government.
If we get this right, if we demonstrate the impact that effective
social care can have and the savings it can bring to the taxpayer
the white paper presents us with far more opportunity than threat.
But if we get too wrapped up in arguments about how social care can
compete with the health juggernaut we will cause ourselves nothing
but problems. Because as with the current not-for-profit debate,
the surest way to get rolled over is to stand in the middle of the
crossroads arguing among ourselves.