Disability: Premature Deaths

Lord Adebowale Excerpts

Monday 17th October 2016 Lords Chamber

[Lord Adebowale (CB)]

I thank the noble Baroness, Lady Hollins, for introducing the debate and I pay tribute to the inspirational late Lord Rix. I will share some observations on the healthcare experience of the people we support at Turning Point. I declare my interest as chief executive of that learning disabilities service provider, which for over 25 years has supported over 450 people with learning disabilities across England. Our experience is that the healthcare and well-being experience of the people we support varies greatly around the country. The following are anecdotal but representative examples from our services, which show that while some progress has been made, more still needs to be done—a kind of reality check, I guess.

The people we support with a learning disability rarely see a learning disability nurse during a hospital visit. We find that we still have to question “do not attempt resuscitation” orders for some people we support. The people we support find that community healthcare provision varies greatly across the country and that there are gaps in specialist support for more complex and behavioural needs. The people we support struggle to gain reasonable adjustments, such as fixed-time GP or clinical appointments, which are particularly important for anxious people with autism or behavioural challenges. With regard to integrated health and social care, the people we support find their well-being needs filtered by assessors using expressions such as “health wants” and “health needs” in their assessments and reviews. At the end of their life, the people we support experience delays in being assessed for additional support as their palliative needs change.

We were very pleased to join Warwickshire County Council in launching a well-being service for people with learning disabilities that will give information and advice around health and well-being and help to improve access to health and well-being services. But, to our knowledge, a provision like this is fairly unique.

We are also noticing the impact of funding cuts for social care. These have been compounded by increased costs of delivery due to the national living wage, although we support that. Commissioners continue to be forced to retrench budgets almost annually and, as a result, face difficult decisions about services for those whom we are here to support. While the funding debate continues, people requiring support continue to be those who bear the brunt. In modern-day Britain, the increasing reality for many people with a disability is that they will be provided for to be deemed safe, fed and hydrated—that is deemed enough in many areas.

People with learning disabilities must receive the same standards of care as everyone else, and they must also receive the same level of determination from the Government to lead the improvements that are needed. The recent experiences of the people we support show that change needs to happen faster to improve healthcare for people with learning disabilities everywhere. More funding for social care is needed to ensure that disability services are able to offer more than the bare minimum. I thank the House for allowing me to speak in the gap.

Transparency of Lobbying, Non-Party Campaigning and Trade Union Administration Bill

Lord Adebowale Excerpts

Tuesday 22nd October 2013 Lords Chamber

[Lord Adebowale (CB)]

My Lords, to be honest I was going to go home, because I am number 30 on the list and I have listened to all the speeches—well, most of them. I was going to stand up and declare my interest as the chief executive of a charity and a social enterprise and the chair of another charity, as well as my membership of many others, and then speak in favour of the Bill to provide some light relief.

I think that what is at stake is really quite serious. I have been involved in the not-for-profit sector, lobbying, for about 30 years and I struggle to understand what the Bill is about. In those 30 years, I have yet to come across a member of the not-for-profit sector who would breach the intent even of this Bill. I would be fascinated to know examples of where that has occurred other than the one referred to by the noble Lord, Lord Rooker, who pointed out that there was a picture of a fellow charity chief executive in the Conservative Party manifesto. So there is a real problem with justifying what the Bill is about.

Part 1 has been referred to as being about transparency. There is an over-hackneyed phrase about sunlight being the best disinfectant. That may be true, but partial light creates shadows, and Part 1 creates too many of them. We all know that if you want to get around this you create in-house lobbies. The fact is that Permanent Secretaries and Ministers can list their meetings—we know how it works. The one thing that I find really quite disturbing and which makes me angry is having my time wasted and seeing people being treated as though they are not intelligent enough to know that. Then I sit here and listen to the speeches, many of which have been absolutely brilliant. The noble Lord, Lord Rooker, just about said it all when he mentioned the £3 million versus £30 million. I would love to have the kind of money that I see in the hands of many of the major companies that march through this House lobbying Ministers and civil servants. It is nonsense to argue that we are somehow at risk of tipping up democracy.

More to the point, let us have a look at social history. Do noble Lords really think that the suffragettes, the people who campaigned against slavery or, for that matter, the Tolpuddle Martyrs would have asked themselves, “How much can we spend in Wakefield on lobbying our local Lord”, who then was the only person with the right to vote, “to try to persuade him”—and it was a him—“to take notice of the interests of the poor and the disenfranchised?”. Let us be real. It never happened and it should not happen now. It is ridiculous. Social change occurs because of people outside these Chambers taking up concerns that we do not yet know of and lobbying people such as us and those in the other place precisely when the local and national elections are in the minds of the public and the lobbyists. And so they should. Why? Because they pay for it all.

The noble Lord, Lord Greaves, gave an example of local interests. It must have been a terrible experience but I sat here and thought, “Tough”. That is democracy; that is how it works. People either are or are not persuaded and, frankly, the amount of money spent by people who wish to persuade candidates in a local area is neither here nor there. I can tell noble Lords that people in middle-class areas do not spend a penny, but they use their elbows and persuade people, and they change what happens in local elections. I knew that the noble Lord would want to say something, so I shall sit down.

[Lord Greaves]

It was not a terrible experience at all; it was all part of the fun of local politics and local campaigning.

[Lord Adebowale]

Spoken like a true democrat.

The point is that the Bill is confusing. People cannot see the point of it. The NCVO, the Countryside Alliance and the National Trust are not organisations prone to hysterical statements about government policy; they are considered organisations that think very carefully about what they are going to say in support or in critique of government policy, and not one of them is for the Bill—not one. My e-mail account is full of people saying that this is wrong. It sends the wrong signal about how we value the opinions of people who do not have the privileges that we have to pontificate about the nature of democracy. It insults those people who gather, with or without money, to influence the people whom they put in the other place and who are paid to sit here. It does not create an understanding of how public policy works and how social change should happen in a civilised country and it does not shed enough light on the true nature of lobbying in this country. That is the truth of it.

Frankly, I think that we should start again. I do not think that it is so much a case of a pause or a chilling effect; it will be a freeze, let us make no mistake about that. There will be people who will be frightened by the contents of the Bill. We may well joke about the cost of lawyers. I happen to run an organisation that employs 3,000 people—some people would call us large and well resourced. I tell you now, with all due respect to noble Lords, that lawyers frighten me, not just because they are expensive, but because they do not always bring clarity. You think twice about whether you are going to campaign when you are faced with the complexity of Part 2. Part 1 will, frankly, provide plenty of loopholes—as has been pointed out by a number of noble Lords—and therefore an industry in advice to industry. We know that.

I do not want to hold up the House any further, other than to say this. My concern is not whether charities or not-for-profit organisations are held back; they have more organisation than the people I am really concerned about. I am not that concerned, even, about whether the Bill will impact on the industry of lobbyists. They will find a way around it—certainly as the Bill is drafted, they will have a field day. My concerns are for the people who do not have access and do not understand how this place or the other place works but who have concerns about how their community and how society work, who want to make a difference and who deserve to be heard. Those are my concerns and they should be the concerns of this House, the Government and society.

Public Services

Lord Adebowale Excerpts

Wednesday 12th December 2012 Lords Chamber

[Lord Adebowale]

My Lords, I will start by thanking the noble Lord, Lord Boateng, for his foresight in leading this debate. It is a very important issue which goes to the heart of what we might call a civilised society and the future of social services generally. In particular, it is a privilege to hear my good friends and colleagues, the noble Baronesses, Lady Stedman-Scott and Lady Barker, speak. Their comments were appropriate and timely. I was particularly keen to hear the philosophical reference to the ubuntu—something we should remember not just in the not-for-profit sector but in business generally. I declare an interest as the chief executive of Turning Point. I do not know whether Turning Point is too big or not. I am often amused by this reference to too big or too small in the not-for-profit business but not necessarily in any other business. Ours is an organisation that employs nearly 3,000 people and has services in 250 locations with a turnover of 80 million quid. That is not vanity; it is just a fact, and we will, I hope, make a surplus. The fact that we are not for profit does not mean that we are for deficit. This is an important point.

I want to refer to the not-for-profit sector’s and the voluntary sector’s contributions to health and social care, because that is my interest at the moment, and to the impact of spending cuts. In reference to health and social care, it is important to note that voluntary sector and, although I do not particularly like the word, not-for-profit sector organisations contribute a huge amount across a wide range of public services. I want to restrict my contribution to the health and social care sector, which is the focus of my day job. It is estimated that 57% of the not-for-profit sector workforce is employed in health and social care, which amounts to around 437,000 people. Over £4 billion-worth of health and social care services are provided by charities and social enterprises. Turning Point is a social enterprise. These services provide vital support to people at the sharp end of the inverse care law. It has been an ongoing theme of my existence as a Peer constantly to refer to the fact that those most in need of health and social care services tend to get them least. I could make reference to employment and other services that fit within that law. Often these people are at their most vulnerable and unwell. Not-for-profit organisations have specialist skills when it comes to delivering services to those with complex needs and the ability to innovate and offer tailored services that people can have confidence in was mentioned by the noble Lord, Lord Boateng.

The sheer size of the not-for-profit sector and what it offers means that its contribution to health and social care in particular is invaluable. However, both the public and not-for-profit sectors are facing very difficult times. The cuts are biting and we are all feeling the effects of reduced budgets. Many smaller charities are at risk of closing entirely. I think it is worth repeating the reference made by the noble Lord, Lord Boateng, to the Charities Aid Foundation which showed that one in six charities believe they face closure in the coming year amid public spending cutbacks and falling donations. Not-for-profit organisations are having to think long and hard about how they can remain sustainable when faced with local authority and health budget cuts while maintaining the quality of services and support that they provide to the people that need it. My own organisation, as has been reported and as some of your Lordships will be aware, is having to make some very difficult decisions in order to continue to provide high-quality services to support the most vulnerable people in society. The proposals that we are currently discussing with our staff and union were borne out of economic necessity and the decision to announce them was not taken lightly. The very tough economic climate means that we and other providers are facing the prospect of dwindling local budgets and the changing demands of commissioners who have less funds at their disposal.

I acknowledge that local authorities are working very hard to protect frontline social care services but it is a fact that they are facing a 28% reduction to their government grants. According to the Autumn Statement austerity is now also set to last for longer than expected—at least until 2017-18 if we are lucky—and the IFS has warned that more cuts will be needed in the future to plug the black hole in spending that it has identified of up to £27 billion. Given the vulnerability and lack of ring-fencing around much local government funding, the prospect of further cuts and their potential impact is deeply concerning. Everyone in the sector will have seen Barnet Council’s graph of doom which illustrates the acute social care funding pressure that local authorities are already facing as well as giving a warning for the future. The Government need to ensure that there is adequate local funding in the future so that fundamental social care needs can be met. Local authorities, care providers and the voluntary sector must be able to maintain and protect the quality of services and care that they provide. This is not just about the Government’s enthusiasm for the sector; it is about the Government’s ability actually to acknowledge the challenge facing public services at this time and to work in partnership with the not-for-profit sector, the private sector and the public sector to reverse the inverse care law.