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Session 2006 - 07 Publications on the internet General Committee Debates Local Government and Public Involvement in Health Bill |
Local Government and Public Involvement in Health Bill |
The Committee consisted of the following Members:John
Benger, Committee
Clerk
†
attended the
Committee
WitnessesCouncillor
Gordon Keymer, Chair of Conservative District Councils Group, Local Government
Association
Councillor
Merrick Cockell, Chairman, London
Councils
Martin
Pilgrim, Chief Executive, London
Councils
Elizabeth
Manero, Director, Health
Link
Sally
Brearley, Chair, Health Link
Public Bill CommitteeTuesday 30 January 2007(Afternoon)[Mr. Joe Benton in the Chair]Local Government and Public Involvement in Health BillWritten evidence to be reported to the HouseLGPI 01
Centre for Public
Scrutiny
LGPI 02
London Councils
LGPI
03 Commission for Racial
Equality
4.30
pm
The
Chairman:
Good afternoon, Councillor Keymer. Thank you for
coming. We shall go right into the question
session.
Q38
Mr.
Robert Syms (Poole) (Con): We will start off with first
principles. Why do we need district
councils?
Gordon
Keymer:
I do not know whether hon. Members are aware,
but in the whole of Europe we have the lowest number of councillors per
100,000 people. They will be amazed to know that the second worst
country is Denmark, which has twice as many as we have per 100,000
people. A Danish councillor said sadly that his Government were
following the example of the UK Government and reducing the number of
councillors. It is my view that we need more councillors, not fewer,
and that important point relates particularly to the unitary
proposals.
Q39
Alistair
Burt (North-East Bedfordshire) (Con): Good afternoon,
Councillor. Clause 3 states that the Secretary of State may direct an
authority to make a proposal for a single tier of local government,
“only where he believes that it would be in the interests of
effective and convenient local government”. How do you feel
about that and what do you think of the implications of that approach
for district
councils?
Gordon
Keymer:
The whole exercise for inviting bids for
unitary authorities has been most unfortunate. It has been costly.
There have been no proven records of savings through unitary as opposed
to two-tier authorities. It has caused serious division within the two
tiers of authority, which will take a long time to recover from. It is
a shame because we have just recovered from the experience of Banham
and now we have this. However, it produced a couple of very important
points about
districts.
First,
districts possess service provision and run an extremely tight
operation on that. Secondly, districts must be given every
encouragement to get their services from the most cost-effective source
they can. Thatmay be from the upper tier—the county
council—or it may be from their neighbours. In Tandridge, we are
pioneering a lot of such work and acting jointly with our neighbours
both within Surrey and across the county border. Although I think that
the exercise itself has been unfortunate, there have been some good
things and I should like to see every opportunity in the Bill to
encourage the idea of flexible
working.
To take your
specific point, I am concerned about it. We were promised that 25
January would be a deadline for such matters, and that that would be
the end of it. Mr. Woolas assured us of that, and I am sure
that he did so with the best of intentions. However, we must be worried
by the proposal. It suggests that what has not been achieved by
stirring will be achieved by the Secretary of State, which is
regrettable. If you would like me to propose a change to the Bill, I
can say that the first thing I would hoick out of it is that
proposal.
Q40
Alistair
Burt:
You mentioned that there was no evidence of
long-term savings through reorganisation. Would you be able to supply
that information in written form to the Committee during its
deliberations? Can you provide evidence from your past experience or
the evidence of district councils from their past
experience?
Gordon
Keymer:
I would love to. The difficulty is that there
is no evidence of there being savings. It is a difficult situation. I
have discovered no exercise that has shown that a change from a
two-tier to a unitary basis—let us forget about what all the
consultants are suggesting and the huge savings there—has
produced major savings. To me, that is a very important point. I
understand that councils remain that have still not made up the cost of
the Banham
change.
Gordon
Keymer:
Since
1987.
Gordon
Keymer:
You are right in that I have not, no. It is
not just a matter of saving money. We are here to provide services. I
know that we are supposed to be place shaping. I like place shaping as
much as anybody else, but in the end we are here to provide services.
That is what we are elected for. Services do not get improved by
reorganisation. One of my big worries about the whole process is
connected with the fact that, as districts, we are in the forefront of
service provision, of which refuse collection and planning are
examples. A unitary authority—particularly a large
one—causes that front line to be lost, and my fear is that one
is then left with the lowest common denominator for services in that
area.
My electorate
believe that weekly refuse collection is important. In Tandridge we
still run refuse collection from the back door, and people value that
too—we have just started a new 14-year contract. However, I can
envisage a nightmare scenario in which, had we become unitary, all that
would have gone.
The
Government proposed not a referendum but a conversation with the movers
and shakers. So I went off to find the movers and shakers, of whom I
assumed the vicar was one, in Government terminology, and I mentioned
the problem. He was horrified. I thought,
“Fine”, and we got on in our own way,
as politicians do. But he kept on coming up to me and saying,
“It isn’t going to go ahead is it?”. Then, on 20
January I was able to tell him that no bids would be made in Surrey,
and he was greatly relieved. So there is a real connection between
district councillors and their electorate which I think is very
important—probably the most important aspect of all our
work.
Q43
Alistair
Burt:
My last question is whether you or your colleagues
have any evidence of a tremendous pressure for change in district
councils. When the Bill was proposed, were not you and your colleagues
absolutely spitting at the sheer waste of time and effort that it would
involve? You can be
honest.
Gordon
Keymer:
The answer is yes, but I should like to say
slightly more than that. Earlier, I mentioned that districts are
incredibly tightly run. I do quite a lot both within and outside my
district, though I am leader of it. I have no support at all, and I am
happy about that because I learn a lot, but the distraction that the
Bill would present was therefore of great
concern.
What
particularly bothered us was that the game was unfair. The dice were
loaded such that the counties could put in bids, and the districts had
to wait to see whether they were going to have their heads chopped off.
The alternative, of course, was for districts to get together and make
counter-bids, but that would have meant walking right into the trap,
because it would immediately have been attacked by the county—I
am sorry to use emotional words like “attacked”, but it
shows the damage caused by that type of thing.
In my own county there was a
proposal for three unitary bodies, which copied our current area
working. I stood out against it, and as soon as the invitation was
issued the other districts withdrew, and no bid was put in.
Nevertheless, I felt that it was a particularly damaging operation. We
have to get on with our counties, and the counties have to get on with
the districts, and that sort of approach is not helpful. All in all, I
really do not understand why the Government took that line. I hope that
they keep to their assurance that the number will be limited to eight.
I would prefer none at all, given the unproven benefits of unitary
authorities.
Q44
The
Minister for Local Government (Mr. Phil
Woolas):
Thank you, Mr. Benton, for this
historically unique opportunity for a Member of Parliament in my
position to quiz the leader of the district councils. I promise to be
briefer than when the situation is the other way round. The Government
have a good relationship with the District Councils Group and we value
its input.
Do you
accept, Gordon, that there are districts that have made proposals for
unitary authorities and that the Government were under significant
pressure to make a decision on process? Do you accept that, in the case
of Surrey—I think that you confirmed it—there is no
proposal? Do you also accept that districts as well as counties can
make proposals? Do you accept that the bid that I understand was
considered by Surrey county council would, according to that council,
have saved it £40 million? That is the council’s figure,
not mine. Given the process, do you accept that the Government do not
have a predilection and that the power to direct cannot and could not
apply in Surrey and in Surrey districts?
Gordon
Keymer:
I said that at the beginning, andI
take your assurance that that is right. On the£40
million savings, they would say that, wouldn’t they? I was
concerned that we did not enter a situation in which further council
tax payers’ money was wasted in going through the figures that
had been put through by the county. The main point is that the county
decided not to put in a bid—that is very
important.
I have to
take your word, Minister, as regards the pressure that you were under.
I came to a meeting in London with David Miliband. The meeting was very
useful and well represented and we had an interesting debate. However,
I saw no great pressure there, but you may have been subject to
separate approaches of which I am not
aware.
Q45
Mr.
Neil Turner (Wigan) (Lab): To follow what the Minister
said, why is it that if districts are such a good thing, some of them
want to become unitary?
Gordon
Keymer:
I think that it is very important that every
district, county or whatever is free to choose. I can only speak from
my own experience. An authority may wish to change for a number of
reasons. It could be concerned about service delivery, but I do not
want to enter into a debate about the services provided by the two
tiers. However, I know that districts are very worried about it. I
think that certain aspects of that issue are very important, so much so
that I wrote a paper on trying to resolve the famous problem—I
do not think that it exists, but it is often raised—of the
question of public confusion.
I suggested that a way of
resolving the problem was to do, if you like, a telephone test. If a
person had a problem—it could be with refuse, or it might be a
pothole—they would ring a local councillor or, in other
circumstances, a local district councillor. I am sure that we can reach
an excellent way in which to operate. Where problems are more strategic
or technical, such as with education and social services, a person
would ring their county councillor. That problem has caused
difficulties in various areas, and I can understand why some
authorities would want to go down the unitary track. I regret that,
because I take Mr. Burt’s point that authorities are
heading for very serious problems when they go through that
process.
There is
another issue. With some cases, there is a hope that by going unitary
and hoping the bid will be accepted by the Government, all the cards
will be thrown up in the air, and the new stack will be so new that all
the authority’s financial problems will be resolved in a minute.
Of course, they will not. However, the new regime will be able to blame
it on the old one.
There are various
reasons why councils may apply to become unitary. I do not believe that
it is a good idea, because I find that the two-tier system works well,
and I worry about representation for local people in a large
authority.
Q46
Patrick
Hall (Bedford) (Lab): Can I ask you whether your personal
view on the subject is the same as the view held by the District
Councils Group that you chair? Does the group have a policy on going
unitary?
Gordon
Keymer:
May I make it clear that I chair the
Conservative district councils grouping and I am its leader? It is the
group’s view—it has never argued against my
haranguing—that my view is the correct
one.
Q47
Patrick
Hall:
I am sorry, I have been misinformed that you are
chairman of the whole group—that was the information I was
given. As chairman of the Conservative group, are you advising
Conservative groups on district councils not to support or enter
bids?
Gordon
Keymer:
No. I respond to their cries for help and
advise accordingly. I believe in everybody having the right to do what
they like. In an ideal world, I believe that there should be no laws.
We would all be out of business, but it would be great. Working on that
basis, therefore, it is up to people individually to decide what they
want to do with their own authorities.
People come to me with
particular problems. One interesting example was the concept that was
developed of the three options: you had to go for unitary, under
invitation, pathfinder, or enhanced status quo. That can be interpreted
from the invitation, but it was read—and encouraged—by
certain people who wanted to go for unitary as meaning that you had
to put in an application for enhanced status quo. This was going on
right up to the very last days, running up to 25 January. Thanks to a
helpful presentation to the Local Government Association by somebody
from the Department for Communities and Local Government who, having
been pressed by somebody who wanted to go unitary, said, “No,
that is not the case”, I was able to say, “No, this is
not correct.” It is those sorts of inquiries that I try to deal
with.
One of the
difficulties under the executive system, as opposed to the committee
system, is that large numbers of councillors are unaware of what is
going on at any particular moment. Advice was given on how they could
tell their back benchers or front benchers, or whatever they are called
now, how they could best handle these particular questions and try to
spread a certain realism. I was getting questions both from county
members—not just from Surrey, but from all over the
country—and district members who were seeking
clarification.
Q48
Tom
Levitt (High Peak) (Lab): It has to be said, for the
record, following the point made by my hon. Friend the Member for
Bedford, that every member of this Committee thought that we were
interviewing the chair of the district councils group of the LGA. There
has clearly been a mix-up here. Do not blame it on the councillor at
all. Obviously, there has been some misunderstanding along the
way.
However, back to
questions. I will endeavour to follow the high standard of forensic
objectivity established by the hon. Member for North-East Bedfordshire.
There is clearly a trend in the Bill for a movement towards all-out
elections every four years. That supports the model of an elected
mayor, which we will come on to in part 3. But at the moment a large
number of the councils that have annual or third, third, third
elections are district councils. Do you see district councils following
that trend or maintaining a third, third, third scheme, which some
would regard as preferable?
Gordon
Keymer:
First, the fact that the choice is in there
is excellent. I fully support that. When we got control of our own
council, the first thing we did was have a public referendum and then
write to the Government, saying, “We want to move to all-out
elections; at the moment, we are in thirds.” We were told that
the Government wanted more elections, not fewer. I am very pleased
about that. I think that it is very important. But I would not go
further than that, because I think that it is a classic case of local
choice. There are strong arguments in favour of both. I personally
believe that four-yearly elections are strategically much better. If
you get anything near to a hung council, annual elections are a
nightmare: you never stop campaigning and if one side produces a good
idea, the other side has to show that it is bad because they fear that
it will be used in the next election. I support four-yearly elections.
On the other hand, thirds is much better for running an efficient
election operation. I think that it is very much open to local choice.
In fact, I would have to go back to my own authority again and say,
“In 2000, you wanted to go for all-out elections. Do you still
want to do that?” I welcome the opportunity very
much.
Q49
Tom
Levitt:
Some might say that the choice is restricted,
because those that have all-out elections every four years are not
being given the choice to move to third, third, third. Do you think
that the choice should go both
ways?
Gordon
Keymer:
I come from a council that has a modified
committee system, which I am very pleased about and which I
wholeheartedly support. I think that that is the best system—I
sorry that that is going to cause terrible horror in local government.
I have mentioned the problems of executives. I regard the committee
system as open and transparent. It involves back benchers fully in the
work and allows scrutiny before the action takes place, rather than
afterwards. So if you are talking about choice offered under the Bill,
I do not think that there should be a prescription on choice. I think
that it should be up to the local authority and the local people to
choose whichever method they believe is the best one for
them.
Gordon
Keymer:
I think that there may be a move that way,
but it is not as clear-cut as it appears. Weneed to think
about it again, because people can seethe counter-arguments.
Peter Ainsworth’s august predecessor was Geoffrey Howe. I used
to discuss with him the idea of having all-out elections. He was very
much opposed to that and gave good reasons at the time. I really must
think again about whether things have changed that much since his own
very clear views on the
matter.
Q51
Andrew
Stunell (Hazel Grove) (LD): You gave an excellent answer a
few minutes ago to what was probably my question, so maybe we could
rehearse it again. You have a modified committee system. It is
based on population size and so on, which is what allows you to have it.
Do you agree with the Local Government Information Unit’s
estimate that thenew proposals will in fact centralise power
more strongly, possibly to the detriment of local democracy? Following
on from that, would you welcome an expansion of access to the modified
committee system for larger authorities as
well?
Gordon
Keymer:
Yes. I really do believe in it. In fact, I am
so convinced that I am rather sad and sometimes go down in the evenings
to watch my committees at work, thinking, “Here are people who,
from the very beginning, can involve themselves in local government,
learn to speak and debate with officers and graduate to the council
chamber and the full council meeting.”
What is happening too much at
the moment in the executive system is that council meetings are
dominated by two or three people and the rest are spectators. The
figures speak for themselves—note the turnover of people who
stay for only one term and leave because they are frustrated. The
trouble is that we are trying to produce a whole lot of mechanisms to
keep them happy by extending scrutiny and so on. If you look at it
quite cold-bloodedly, all those things could be covered by active
membership in the committee system. It is a great shame. People are not
easily fooled.
How do
we involve councillors? I have said that we need more councillors, so
obviously I want to ensure that those who do come stay. I know how many
of mine have come up through the committee system and are now proving
very good chairmen and vice-chairmen of committees. I am thinking in
particular of one excellent young person who is actively involved in
debating for council, whereas when he started he was very taciturn and
did not really contribute. He has changed enormously, and I believe
that that is due to the committee system. I do not think that he would
have changed if we had an executive
system.
Also, an
executive system unfortunately appeals in some ways—I shall put
this carefully—to the baser elements of human nature. Humans
tend toward secrecy. They want to keep things to themselves and keep
other people out. If we want an example of how that happens, the recent
exercise on the bids for unitary and the way that I have been
approached on it shows how devastating the executive system can be.
People were able to get an incredibly long way down the track toward
the finishing line in preparing a unitary bid before the members
finally realised what was going on—running a group with a
committee system, I cannot understand that—and put the brakes
on. It is quite extraordinary. Perhaps Government money could be well
spent in comparing the two in a case study of authorities where bids
were and were not put in, what the mechanics were to get there and why
the bid looked in some cases as though it were going in but did
not.
Q52
Andrew
Stunell:
So you would say that the decision making was
more thorough and produced better results under the enhanced committee
system?
Gordon
Keymer:
I believe that it is. I believe that it is
also better with a relationship between members and officers. At a
committee meeting, you have a chance for open debate and questioning.
One can argue, as my former chief executive argued, that there is no
point
having scrutiny committees in the committee system because the scrutiny
is done beforehand and that it is difficult to grasp why something
should be studied after it is done, when surely it would be better to
study it beforehand. That is what the committee system does. After all,
the committee system goes back many centuries. It will come back, and
we will see that it must come back at some stage. I am sorry if that is
not what the Government want to hear, but you
asked.
The
Chairman:
We move to part 5, which deals with the
co-operation of English authorities with local
partners.
Q53
Lynda
Waltho (Stourbridge) (Lab): Some have expressed concern
that the proposed community call for action could become a
nimbys’ charter or a vehicle for extremist individuals or
organisations, or that it could be used in a frivolous, vexatious,
malicious or politically motivated way. Do you agree and what
safeguards would be needed to prevent
that?
Gordon
Keymer:
I am sorry to raise the subject again, but I
repeat that the committee system allows the community call for action
to be made more effectively than the executive system. In fact, in many
ways, the community call for action—and I understand the drive
behind it and welcome that—is, in many ways, a bolt-on in an
attempt to deal with the problems of the executive system. As you have
asked for the problems, one huge one is that of raising expectations. I
imagine that Committee members find that with their own electorates.
People hear about the community call for action, and one of the
difficulties that we have in local government is the difference between
those with a universal franchise as a mandate and those who have formed
a pressure group.
That problem is going to
increase as cynicism with politics as a whole increases. One has to
look very carefully at whether we are going to encourage that by
suggesting that, in some way or other, you can by-pass your council
processes to have your particular case brought forward. Let us leave
aside the question of costs. However, a protection could be built into
the Bill to ensure that councillors were not under great
pressure—it could be a question of choice and whether they
wished to take up the
issue.
There is also
the question, of which you are probably aware, of certain areas of
crime and disorder which—I think I am right in saying and the
Minister will be able to tell me whether I am correct—have been
excluded from this particular area and are not directly under the
community call for action. That is, in practical terms, a problem
because trying to explain to people whether it falls under the call is
something that might be worth looking at a bit more carefully in
drafting the
Bill.
Mr.
Woolas:
Thanks very much to Councillor Keymer for
highlighting that. We will be discussing that when we move on to the
Bill, but it might be helpful to point out here that the community call
for action process, as far as crime and policing are concerned, is
covered by the Police and Justice Act 2006, which has yet to come into
effect. The
mechanism and process being proposed in this Bill
are different, although similar in essence. The difference is that
under this process it is the councillor who triggers the call for
action on behalf of his or her constituents. That is the difference.
The point, in other words, has been taken on
board.
Q54
Tom
Levitt:
With the move from taking responsibility for
standards away from the national body and putting more emphasis on
local councils to run the show themselves, is there a risk of national
standards being lost and of having different standards applied in
different places? If so, how do we account to
members?
Gordon
Keymer:
I know that questions have been asked about
whether districts can handle standards. From my own experience, I think
that they have coped very well indeed in difficult circumstances. I
laugh when I think back to an early meeting of the Standards Board at
which it was worried that it would not receive any complaints. That
struck me as being a bit like Robespierre worrying about whether anyone
would be denounced in the French revolution. My view—and I think
that of my party—is that we should abolish the Standards Board.
However, taking your particular point about local standards, yes, I
think that it can set local standards. However, there is one particular
issue which I have been looking for in the Bill—and again I hope
that the Minister can help me on this because I have not been able to
find it—and which was in the White Paper. That is the very
important issue of allowing members to be more directly involved with
areas that directly affect them—the old problem of the planning
application for the house down the road.
In the White Paper, the wording
was “unless their interests in the matter are greater than those
of most other people in the ward”. I have looked through the
Bill and I cannot find that reference. However, if it does come up in
discussion, I would just say that I am worried that we will have
another problem because, from my point of view, a member’s
interest will always be greater because of their need to get elected.
That is a very serious issue.
I believed that we were heading
towards a situation in which no member could speak about a planning
application in his or her ward, let alone down the road, because they
were under pressure and worried about getting votes. If you have 100
residents complaining about something, you think very carefully about
how you make your representation. I support the idea, although I think
that it needs greater clarity, but I worry that the wording might make
things worse than they are at the
moment.
Q55
Tom
Levitt:
I am sure that there will be codes and
guidelines covering the operation. Do you think that there would be a
problem if a tight interpretation of the guidelines were applied in one
council ward and in the ward next door, in a different council, a
different standard were applied? Do you think that that might
happen?
Gordon
Keymer:
I was talking about districts working
together on service provision. That is an area that has been
accelerated and boosted, and I hope that the Government will try to
find further ways of doing
that. That is a great plus that has come out of the bidding process, so
it has not all been bad. I think that we need to work together in the
same way on that.
I
was directly involved in defending a rather tragic case of a new
councillor who very quickly became caught up in the machinery of
council in a way that any innocent could easily have done. He found
himself the subject of a complaint to the Standards Board as a result.
It took two years to be adjudicated, which came back to his own
council. In the end, he was told that he had to have further training.
That councillor is very good, but I would be very surprised if he
stands again. If I were he, I would not. Whatever we do, we must get
round this erratic and damning way. Worry is a terrible thing, and it
is hard for a councillor to have this hanging over him for two years.
It may seem strange, but people do worry about that sort of
thing.
Q56
Alistair
Burt:
We are all worried about how standards are handled.
We all understand that it is no longer possible to have a complete
free-for-all and self-regulation to protect the public; finding a
common base is therefore important, yet you highlight the individual
problems that have bedevilled the Standards Board since it was
introduced. From your experience and that of your colleagues, do you
see any way that we could amend the Bill to get to the heart of those
worrisome concerns? It is a matter held in common with us all: we want
to encourage people to stand as councillors and we want the public to
know that there are good standards on the council. But the impression
has been gained somehow that because of the existence of the board,
there is more trouble at local councils than ever before. Has your
group of district councils been able to think of a way to amend the
Bill so that it achieves more of what we are all genuinely searching
for?
Gordon
Keymer:
I think that at the moment, you
have proposals for having an independent chairman of the Standards
Board. In the end, I am laissez-faire. Although I accept your concerns,
and in any situation there are going to be problems, there is already
the law. The most serious cases have usually involved the law directly,
and the Standards Board has not made a difference. We therefore have
the problem of how to deal with standards that are not directly to do
with the law, but are just expected to be high standards. I think that
you are on the right track in that the local standards committee is the
way to go. Each council having its own set standards with guidelines is
by far the best course.
Let us be quite clear: we are
all politicians and we all have problems of public perception, as I
mentioned earlier, and we all have a responsibility to deal with that.
However, it will be extremely difficult. It is not just a UK problem;
it is a European problem and probably a worldwide problem, I suspect.
Within that, we have to produce guidelines in which people operate. We
will have to see how that works. At the moment, we seem to have
drawbacks that are far greater than the benefits. I do not have a
feeling that people have been coming up to me and saying,
“Councillor Keymer, I have much greater confidence in my council
now because we have the Standards Board.” I would like to see
guidelines. The guidelines are there, so let us give it
a go. If it does not work and we find that there are
serious complaints and concerns, then we should look at that.
I look back at Donnygate. What
was Donnygate but a cabinet system by another name? We should work out
what the problems are first and then try to deal with them. However, I
think that the standards that we have set within our own councils and
standards committees are working well at the moment. Although I have
welcomed cases being submitted to the Standards Board, I have not
encountered any cases—at least locally—that have gone to
the Standards Board and that have been the subject of a good decision.
In most cases, the relevant people have been damaged, which has been
neither to their benefit nor to the benefit of people at
large.
Q57
Mr.
Woolas:
I want to follow up on your point about an
independent chair. Is it your view that it would be better for local
committees to be constituted by a majority of councillors, or by a
majority of independent people? Do you have a view on
that?
Gordon
Keymer:
Yes: I believe that they should be made up of
councillors. In a perfect world I could understand where you may be
coming from in relation to the advantages of having independent
members. Unfortunately there is a practical problem with what I
mentioned about pressure groups. I do not necessarily know what other
councils have found, but finding independent members is difficult. I
think of a case in which I defended one particular chap. People do
their best but they find it difficult to grasp the difficulties under
which a councillor works. The argument is probably one of the oldest
that there is: does the professional body exercise discipline or does
one get outsiders to do the task? Normally there is an element of
outside people, but I should like a majority of councillors on the
committee.
Q58
Alistair
Burt:
You might be able to obtain a majority of
councillors and yet have sufficient independent people on the board to
ensure that there would not be a group majority—to ensure that
there would not be any political councillors’ majority. That
might be a way to balance the
interests.
Gordon
Keymer:
That is a good suggestion, although, to be
fair, it is hard to say that because someone is in the same party they
will necessarily be much more lenient. The assumption might be an
obvious one, but it is not necessarily true. There should be
independent members, because if they are carefully selected they can be
helpful. Ultimately, however, I am keen that, as in Parliament, we
should do our best to police ourselves. It would be a sorry day when we
had to introduce total independence to look after
us.
Q59
Alistair
Burt:
I take your point, but one could think of cases in
which it would be difficult to persuade the outside world that a case
had been fairly handled if an unfortunate decision were made and if
people could point to a majority of councillors who were of the same
party as the individual concerned. The appearance of fairness is
important as
well.
Gordon
Keymer:
That is a very good point. The case that I
was referring to was that of a large London council that was
Labour-controlled, and the person concerned was a Conservative. There
is no doubt in my
mind that the councillors present handled it very fairly. I agree that
perception is important, but on the other hand there is a deeper
perception that we—we all have to deal with it—must do
something to address cynicism about politicians as a whole. One can
take a “sticking plasters” approach, but the issue is an
important one.
The
Chairman:
I think that that brings us to the end of our
questions. For the record, in relation to the confusion on the precise
title of Councillor Keymer, I point out to the Committee that the
wording in the motion agreed to by the Committee was unchanged from
that tabled by the Government in the Programming Sub-Committee. I thank
you for attending, Councillor
Keymer.
Gordon
Keymer:
May I clarify? By far the biggest group in
the Local Government Association is the Conservative group of
councillors, which I lead. Technically, however, I am not the leader of
the whole set-up. The independent group leader is a district councillor
and he or she acts, effectively, as the head of the whole set-up in the
form of chairing its meetings. But we are by far the largest
grouping.
Mr.
Turner:
On a point of order, Mr. Benton. I do
not say that we have wasted our time, but a lot of our time could have
better spent if we had had somebody from the Association of District
Councils who spoke for the whole association, rather than just the
Conservative party. I am not blaming the witness that we have just
heard. In fact, I am not blaming anybody, but we need to bear that in
mind for the future, because we are learning as we make our way
through. There are district councils that are in favour of unitary
authorities, but we have not heard their point of view and I think that
we should have had
that.
The
Chairman:
That is not a point of order, of course, but it
is, perhaps, something for future Programming Sub-Committees to bear in
mind.
Alistair
Burt:
Further to that, can we hold our hands up? It is
perhaps part of the process of being very quick. My impression
certainly was that the councillor was the chairman of the Association
of District Councils. We advanced our arguments in good faith. Clearly,
there was no system of checking, given the speed with which it was
done, and we all worked on that basis. But there we are; we learn a bit
from that. He was still jolly good though, wasn’t he?
[Hon. Members: “Hear,
hear.”]
The
Chairman:
We move on to the next group of witnesses.
Perhaps the witnesses would like to identify themselves.
Merrick
Cockell:
Good afternoon, I am Merrick Cockell. I am
chairman of London Councils, which used to be called the Association of
London Government. Martin Pilgrim, our long-time chief executive, is
known to many of you. The Association of London Government—now
London Councils—represents all 33 London local authorities. I
happen also to be the leader of Kensington and Chelsea borough
council.
The
Chairman:
Thank you very much for coming. We shall start
with part 4 of the Bill, which deals with
parishes.
Q60
Robert
Neill (Bromley and Chislehurst) (Con): I am grateful for
the seamless transition which I hope will not come as a complete shock
to our two witnesses. Actually, it may, because they have never seen me
move so fast.
Do we
really need urban parishes in
London?
Merrick
Cockell:
I think back, Mr. Neill, to
discussions in a different place when we were both on the Commission on
London Governance. We looked at the various options for London’s
government, including urban parishes. After an exhaustive afternoon
spent with various representatives from, I think, Milton Keynes, we
reached the conclusion that this really was not necessary for London. I
am not going to oppose the concept of subsidiarity, because all London
authorities are committed to that in its various forms and all of us
operate those according to our needs. In our memorandum, there is
evidence from Croydon and one council from each of the political
parties giving examples of their current mechanisms, which work
well.
We found that
“parish” is a term that covers everything from 71,000 in
Weston-super-Mare, down to tiddly little groupings where no one ever
bothers to stand for elections. Of course, our London wards have
populations of about 10,000 or 11,000, which seems to be the average
for parishes. Our view was that, as a principle, we have already got
that direct connection between directly elected representatives and
their
communities.
Martin
Pilgrim:
If I could add to that. We were here for the
last evidence session and I was taken by the references to the role of
back-bench councillors in authorities with an executive-scrutiny split.
It seems to us that the danger of having parishes in London is that it
would detract from the representative and local action role of ward
councillors. We should be seeking to build upon that, rather than
creating a new set of arrangements on top of what we have
already.
Q61
Robert
Neill:
A significant part of the report from the
Commission on London Governance talked about enhancing the role of the
councillor as local champion and it cites various ways in which that
might be done. Perhaps we might have an opportunity to have a look at
that.
As we know,
political parties are in operation in some parts of London with elected
members, even under our current system, whom we might not be happy to
see dominating a parish council if it were based in a particular local
government area. I know that London government is concerned that there
should be pretty rigorous controls to prevent a council that decides
that it would not be in the interests of community cohesion to have a
parish that might be dominated by an extremist element from being taken
to judicial review if it refuses the petition. Is that covered
sufficiently in the Bill or we do we need further safeguards? If so,
what?
Merrick
Cockell:
No, our view is that it is not sufficiently
detailed in the Bill and we hope that you can
address it. Clearly, we are grateful that the
Government have listened at an early stage. We have
accepted that the Bill is a Government manifesto commitment, but they
have listened and given the ability to approve to the local authority.
That is a major step forward. However, as you have said, we need to
ensure that if a local authority concludes that, on the grounds of
community cohesion, it is opposed to the setting up of a local parish
or parishes, it will be able to be safe and secure in that
determination.
Your
example of political extremism is the most obvious concern of us all.
We have only to look back to the May elections to see where an
extremist political party could easily have gained control of one
London borough, which would not have been good for the whole process.
The opportunities could easily be seen in London parishing. That is one
side of it.
The other
side, which has its dangers as well, is of a particular, probably
geographically based, grouping, perhaps of people who objected to their
local authority trying to apply a policy—it could be a variety
of things from finishing off a parking zone system to include the whole
borough—seeing it as a means to oppose that and to protect or
even advantage. Most London boroughs have areas that are particularly
wealthy and they may wish to separate themselves from the problems and
the wider community by setting up themselves as a parish council, with
the ability to precept, inevitably requiring a bureaucracy and those
other incumbencies that might go with it. There are at least a couple
of risks around community cohesion in the wider
sense.
Q62
Robert
Neill:
Have you done any work on the possible costs of
setting up an establishment in London? You have talked about
bureaucracy and setting up
costs.
Martin
Pilgrim:
We have not, but we have cited evidence that
we produced in a publication that we plan to let members of the
Committee have after the
meeting.
Martin
Pilgrim:
It is evidence of the scale of parishes in
the rest of the country. As Councillor Cockell said, they can vary and
be quite large. In some parts of the country, the expenditure by the
parish council is greater than the expenditure by the district council
in the same area. That must carry with it a bureaucratic
overhead.
Q63
Robert
Neill:
I say that specifically because I remember in a
different life defending the clerk of a large parish council who ran
off with the funds. I was surprised that there were a lot of funds to
run off with. It was quite a problem. Perhaps you would also supply
members of the Committee with the report of the Commission on London
Governance on that
point.
Martin
Pilgrim:
Yes, with
pleasure.
Q64
Tom
Brake (Carshalton and Wallington) (LD): May we return
briefly to your concerns about parish councils being established by
extremist parties? Have you put specific proposals to the Government
that would provide the necessary safeguards? Have the Government have
rejected them? What is happening with the proposals that you have put
to the Government?
Martin
Pilgrim:
We are in a continuing dialogue with the
Government. As was said earlier, the proposal for parishes was first
mooted two years ago. We raised our concerns then. We were pleased to
see in the White Paper that the Government recognised our concern in
two ways—first by devolving the power to create parishes to, in
our case, London borough councils, and secondly by making it clear that
community cohesion would be reasonable grounds for rejecting a parish.
We are still in discussion with Government at ministerial and official
levels about whether the Bill’s present provisions will give us
enough strength to resist parishes on grounds of community cohesion. We
are discussing whether we need probing amendments, and we are talking
to officials and Ministers about it all the
time.
Q65
Tom
Brake:
Do you yourselves have a form of words that you
feel confident would address all your concerns if it were in the
Bill?
Martin
Pilgrim:
With our legal advisers, we are working on
that form of words. Our concern is that we would really like our
decisions on such things to be completely judge-proof, and clearly that
is unattainable in law. We are looking to see how we might strengthen
it. Subject to our continuing discussions with Government at official
and ministerial level, we will return to the Committee with ideas as
your thoughts develop, or at later
stages.
Q66
Mr.
David Burrowes (Enfield, Southgate) (Con): In terms of the
grounds to refuse the creation of a parish, would you not want more
discretion and freedom to refuse, rather than being pigeonholed into
refusing on grounds of an adverse effect on community cohesion? What
about taxpayers’ concerns about the cost, or the borough
taxpayers’ overall right to
choose?
Merrick
Cockell:
Having urban parishes as one of the choices
before a local authority is right. There might be circumstances in
which that will fit. To give too many opportunities to oppose things
might not be to our benefit. Our concerns revolve around the threat to
our communities’ ability to operate together within the whole
authority and indeed beyond a single authority—to take that
wider viewpoint—rather than having, as I said at the very
beginning, a natural opposition to the concept of passing powers
down.
Q67
Mr.
Burrowes:
I am not suggesting that, but are the only
grounds for refusal community cohesion? Do you not think that that is
one ground, not an exclusive ground for
refusing?
Merrick
Cockell:
Those are the only grounds that we as London
Councils—
Q68
Mr.
Burrowes:
I appreciate that, but in terms of looking to
advise on the Bill, would you want ideally to have other grounds than
community
cohesion?
Martin
Pilgrim:
One philosophical difference between grounds
of community cohesion and of cost is that the people themselves in the
parish area would vote for and incur that extra cost, whereas our
consideration is the effect on the wider community. To go back to
Councillor Cockell’s point, we cannot be against subsidiarity.
If people want to vote for more expenditure, that is up to them. Our
concern is the effect on the rest of the
borough.
Q69
Alison
Seabeck (Plymouth, Devonport) (Lab): Forgive me, because I
am probably not as expert in such matters as you, but is there not
scope with the community governance reviews for applications to set up
parishes to ping-pong? There could be a petition asking to set one up
and then a petition saying, “No, we don’t want
it.” Do you have a feeling about whether the Bill as it is
drafted sets any time limit on that between, for example, a parish
being established and another petition saying, “We don’t
want it”? For example, if the BNP or some other extreme group
took control but the wider population thought, “This is not
good; we’ll get up a petition to disestablish it.” what
would the situation be in relation to the
legislation?
Merrick
Cockell:
I have not really thought through a massive
petitioning to establish and then to disestablish, but I can certainly
see circumstances in which a political extremist organisation
campaigned to set up a parish and other groups would literally go on
the streets to oppose it. That in itself would be extremely damaging,
if we imagine it being fought out at local level. I had not considered
it, but that ability would be troubling. It would not be prevented by
current proposals, because one would have to have gone through the
process before the local authority could take a view whether it would
support or agree to a parish being set
up.
Q70
Alison
Seabeck:
I am advised that there are two years before a
petition can come in after one has been established. The scenario we
have been discussing is two petitions running in an area at the same
time, and what that might do for community cohesion.
Merrick
Cockell:
Yes—and then, of course, the wider
community being drawn in, not only those who are being petitioned. That
is at the very root of our concerns about community cohesion. Our
concern is that a wider area of London could be thrown into
disarray.
Q71
Tom
Levitt:
I think everyone will agree that the enhanced
roles of the community and voluntary sectors both in influencing policy
and in helping deliver services as partners with local government have
been healthy. How can we make those partnerships work even better on
structures such as local area agreements and local strategic
partnerships, which bring the voluntary and community sectors in to
work with local authorities?
Merrick
Cockell:
I will speak from my own experience of my
borough. I chair the local strategic partnership, and I think that it
is a good principle that the leader of a council does so. It is an
essential partnership that needs a stamp of recognition and approval
from the democratically accountable leadership.
The relationship with the
voluntary sector has taken time to evolve, in my experience, but we
have got there. I think that that applies to other strategic
partnerships as well.
However much local authorities
try to involve the voluntary sector and others—business sector,
tenants, and so on—in the creation of local area agreements,
they very much end up as a local authority-led
procedure as regards negotiations with the Government office and those
sorts of things. More could be done directly to involve the strategic
partnership members, the wider voluntary sector, the business community
and so on.
One of the
concerns about the proposals is that the local targets the local
organisations, be they the council or voluntary sector, set seem to
have less importance within LAAs, and are viewed in a different way
from the nationally imposed targets. I think that that is regrettable.
If a community accepts that the Government have a legitimate right to
their targets, but adds to those, the local targets should be as
important as national targets.
Q72
Tom
Levitt:
Do you think then that the voluntary and community
sectors have played a positive role in the LSPs and LAAs in your
area?
Merrick
Cockell:
It is a mixed picture overall. If there is
one common thing about local strategic partnerships, it is that we are
all looking to see who is doing it well. I do not think that any of us
feel that we have really got it sorted out. There are different
varieties, but I think that the direction of travel has been positive.
A lot of the tension and perhaps distrust that was there at the
beginning is being worked through. It requires constant application and
willingness to be involved, and it can be tricky, because the voluntary
sector and other sectors inevitably feel themselves to be
second-quality partners to the statutory authorities, which control the
money, officers, mechanisms and those sorts of things. Some of them
have a right to do that through the democratic process, but others can
dominate the process. Therefore, you have to take particularly positive
steps to draw in other groupings that do not have the power of budgets,
or any power.
Q73
Tom
Levitt:
As far as controlling the money is concerned, I
believe that London Councils quite significantly cut the amount of
money that is given to voluntary organisations. Has that helped or
hindered the process of trust building?
Merrick
Cockell:
I am grateful to be here to put right that
misconception. The budget for the next financial year as exactly the
same as that for the last financial year—it is a frozen budget.
We have started commissioning and to refocus our priorities. From your
earlier conversation, I am sure that you will be glad to know that we
have done that across the parties—the three political
groupings—and indeed the City of London in its independence, and
we have worked out those new priorities for London. It is still about
£26 million, which is a lot of money. The publicity around an
initial proposal to cut the budget by a third was no more than
that.
Q74
Andrew
Gwynne (Denton and Reddish) (Lab): I am interested to hear
what you have to say about how London Councils works jointly with its
partners and about the co-operation across London boroughs. Do you
think that the provisions in the Bill go far enough to require partners
to co-operate with local authorities or should the proposals go
further?
Merrick
Cockell:
Certainly, we are co-operating with an
amendment, because I think the list is
incomplete.
Martin
Pilgrim:
One of the issues for us is whether the
Bill, as it is drafted, picks up all the London agencies, particularly
around the Greater London Authority and its functional bodies, with
whom we need to do business. There is a downside to that as well,
inasmuch as in our dealings with the GLA, we tend to want to sup with a
long spoon most of the time. So it is a matter of how we implicate the
GLA and get the appropriate partners. Getting the right relationship
with the GLA is important for us. That is one of the issues that we
will be lobbying the Committee about as the Bill
progresses.
Merrick
Cockell:
We are having dinner with the Mayor this
evening, so I will tell him what you just said,
Martin.
Q75
Mr.
Woolas:
May I follow up my hon. Friend’s question?
It was about a regional level, but what about at a local level within
the local authority? Would you like further powers to coerce
co-operation, as it
were?
Merrick
Cockell:
I cannot think that any more powers are
required. Certainly, from my experience—I have done
comprehensive performance assessment reviews on other authorities, so I
have seen the way that they operate—there is a commitment from
other organisations and groupings within London boroughs to be part of
that strategic partnership. I do not think that anybody is insisting.
They vary, so in one you might have the local fire commander being on
the body and in other areas that, for a different set of reasons, just
does not make sense. In Kensington and Chelsea. we have an arm’s
length management organisation that has a seat as well as the
residents’ association representing other residents. That might
be unusual. Others may not do that. Some have a very small group of
under 10 people who actually lead the strategic partnership and that
seems to work for them. I think the structure in itself, within the
community, has to just feel right for that community. Being hamstrung
by Government or legislation does not help. I would say that it has to
be able to evolve naturally. Anything that requires certain structures
that no longer fit in with experience and local requirements would be a
hindrance.
The
Chairman:
Finally, we move to part 11 of the Bill on
“Patient and public involvement in health and social
care”.
Q76
Robert
Neill:
Have you made any assessment of the likely impact
on your member authorities that might arise from the changes that the
Bill makes in relation to public involvement in public health
issues?
Martin
Pilgrim:
For most of this Bill, we have left our
thoughts to our national colleagues in the LGA. My concern with this
part of the Bill would be the extent to which our relationship with the
health service generally is dominated by the immediate issues around
primary care trust budget cuts and how that is being handled within the
health service. To some extent, looking at structures and so on is very
much secondary to the crises that boroughs have to deal with when
coping with rearrangements in the health
service.
Merrick
Cockell:
We have a lot of worries at the
moment.
Merrick
Cockell:
Cost shunting in boroughs such as Brent and
Hillingdon, in particular, involves large amounts. Local councils are
having to put in considerable amounts, which is inevitably being
reflected in the council tax. It is just being announced at the moment.
Overall in London there is a deficit of £135 million in
London’s health service. It is so strongly felt that we have the
chairman and chief executive of NHS London attending our next
leader’s committee next week, having put through a motion at the
last leader’s committee. The issue is of real importance and we
have asked for an emergency meeting with the Secretary of State. We
hope that she will agree to it very
soon.
Overall,
anything in respect of the proposal that connects the local council
better to primary care trusts, in particular, is very important. In
fact, my authority is considering being one of the pilots should the
proposal go through in its current form. One of the difficulties that
we are trying to assist with at London Councils is how the local health
service in the boroughs is scrutinised. At the moment, there is a gulf
between the local PCT, which the local authority has a statutory
responsibility to scrutinise, and the London-wide health authority. We
support a single health authority for London, but there is a gulf
between the two so London Councils is seeing whether it can provide a
scrutiny role, either sub-regionally or for London as a whole. It is
impossible for both sides to deal with PCT-level scrutiny and the next
level of chairman and chief executive London-wide. Somehow we must help
to deal with that. If it ends up with a great connection, we would be
broadly supportive of the
principle.
Q79
Robert
Neill:
From what you say, you sound supportive of the
LGA’s national view that the Bill ought to require the
involvement of the health authorities and so
on.
Merrick
Cockell:
Yes.
Q80
Robert
Neill:
I have just one further point. The Commission on
London Governance has done some work on the relationship that you
hinted at between the boroughs—the primary care trusts in
particular—and how commissioning might go forward to see whether
there were greater scope for collaboration. Is there anything that you
want to add about
that?
Merrick
Cockell:
The state we are in at the borough tier of
London government has a lot of coterminosity between the services. That
applies to the police and to primary care trusts. There are real
opportunities to take that to the next stage. Perhaps not all London
councils are at the same level of being equipped to deal with that, but
there are a considerable number. We have such a high proportion of good
and excellent performing councils in London that we can look at
working with greater responsibilities being with
locally elected politicians for all the public services in their area.
We are working at London Councils with a sister
organisation, Capital Ambition, which is its improvement body for
London. A lot of work is going into how we can do more not only at
borough level and with all the services, but across boundaries with
neighbouring and other authorities. I agree with your views,
Mr. Neill.
The
Chairman:
Thank you. That concludes our questions. Thank
you, Councillor Cockell. Mr. Pilgrim, thank you for your
attendance and your
testimony.
We now come
to the next group of witnesses. We can see your nameplates, but would
you like to introduce yourselves to the
Committee?
Elizabeth
Manero:
I am Elizabeth Manero, the director of Health
Link.
Sally
Brearley:
I am Sally Brearley, the chair of Health
Link. Would you like to hear what Health Link
is?
Elizabeth
Manero:
Health Link is a social enterprise engaged in
patient and public involvement. We grew out of London Health Link,
which was the regional association of London community health councils.
When CHCs existed, we operated across London in the way that was
mentioned a moment ago.
Health Link was formed in
January 2004. We draw views into policy making and policy
implementation, particularly from hard-to-reach groups. We have a
network of 125 lay patient representatives, all of whom used to be CHC
members in London. They have great expertise in monitoring health
services and are also well connected to their local health services.
That is our core of informed people, and from it we have drawn a number
of the patient reference groups that we have been commissioned to
provide. For example, we run the patient reference group for NHS
Connecting for Health in London, on the London “choose and
book” programme, and we ran another group for the London
patients’ charter project board. Sally and I are also involved
in a patient reference group for specialised commissioning in London,
which likewise operates at a pan-London level.
Our model is to draw in the
people with whom we are familiar and who are well informed and well
skilled in patient involvement, and encourage them to influence policy,
but also to incorporate the views of others, who suffer health
inequalities and whose views need to be heard.
Sally
Brearley:
May I also say that I am a member of a
patient-public involvement forum for Sutton and Merton primary care
trust? I also do some work for the Centre for Public Scrutiny on
supporting health scrutiny in London and the
south-east.
The
Chairman:
Thank you. We shall begin with part 11 of the
Bill on “Patient and public involvement in health and social
care”.
Q81
Alistair
Burt:
Good afternoon and thank you for coming. The
Government have praised the excellent work of forums, and the energy
and expertise of those involved. Are the Government right to abolish
them?
Elizabeth
Manero:
The other day, I met someone from my local
patient and public involvement forum who was involved in mental health
and who talked about the despair and disillusionment of the forum
members, many of whom are mental health service users. They had found,
yet again, that they were told, “You are really great; you are
doing a great job, but we are going to get rid of you.” The
message that comes across from that is, “We are going to get rid
of you”, not “You are an excellent resource.”
Actions are judged more than words, and all the other reassurances
about the quality of the forums, which I thoroughly endorse, are
undermined entirely by
abolition.
I
do not agree with abolition, although I agree completely with the
objectives that appear to us to underpin the
proposals—broadening patient involvement and trying to ensure
that it goes beyond a committee-based approach. We endorse that
entirely, but removal of the existing structures, and with them all the
people involved, is a
mistake.
Sally
Brearley:
I totally agree with that. It is
unfortunate that we now face proposals to abolish forums, whereas the
Government previously assured us that they did not intend abolition.
The House of Commons Library research paper 2007/01 remindsus
that, in July 2004, “Melanie Johnson, then Parliamentary Under
Secretary at the Department of Health, said that Forums were the
cornerstone of patient and public involvement” and that she
said, “They will not be abolished, nor will their independence
be undermined.” In the arms length review, which told us that
the Commission for Patient and Public Involvement would be involved, we
were also told that, “Patients’ forums will remain the
cornerstone of the arrangements we have put in place to create
opportunities for patients and the public to influence health
services.”
As
you are aware, it was only in July this year, in “A stronger
local voice”, that we heard that patients forums were indeed to
be abolished. I do not think that abolition is necessary. Perhaps we
cannot return to CHCs, although in some ways I think that that would
not be a bad idea, but there is no need to move to LINKs. We can
achieve the stated aims, which we said we commend in terms of widening
involvement and extending the remit to cover social care as well as
health. We can go forward by modifying, improving and strengthening
patients forums. I do not think that there is any need for us to look
at
LINKs.
Q82
Alistair
Burt:
I appreciate the comprehensive nature of the answer,
which you are perfectly entitled to give. What is it that worries you
most? Is it the fact that it is another reorganisation or is it the
loss of independence, because plainly it is not the Government’s
intention to remove the patient voice? Why do you think that the way in
which they want to set it up will not be as effective as what is
currently there? Will you tell us what you think is missing given that
the Committee might try to do its best to reintroduce what you think is
missing if that would actually give effect to what the Government are
looking for?
Elizabeth
Manero:
I referred earlier to the model that we have
tried to operate in Health Link, namely a core group of people who are
informed, trained, supported and able to sit in a forum like this in
the health service and actually engage and make a difference. That core
is not there in the LINKs
proposals.
Elizabeth
Manero:
Why should they? If they have already been
told that they are so excellent that they are going to be got rid of,
it is a bit of a risk that they will not engage again. That was
difficult enough when I was chair of London Health Link and encouraging
the members of London CHCs to move forward. Many of them did not.
Therefore, if those moved forward again are going to be told that they
are so good that they are being disposed of, it is difficult to
anticipate that they will remain. If there was a provision in the Bill
which secured that continuance, that might be a different matter, but
there is not.
Sally
Brearley:
The proposals are so vague that it is
difficult to see LINKs as a body. It might be a body but not as we know
it. They talk about putting in place a means for delivery and
activities, but it is not at all clear that we will have the effective
body of informed people that we have with patients forums. Therefore, I
think part of the problem is that we cannot see from the details given
in the Bill that we are going to have anything as effective as patients
forums. If we could be assured to some extent that there will be room,
as you said, for existing members of patients forums to transfer to
LINKs, at least that would be something. However, there are other
reservations about LINKs which I will not go into now unless you want
me
to.
Q84
Andrew
Stunell:
You have already dealt with the question whether
the Government were right to get rid of community health councils, but
we have also seen at the national level that the Commission for Patient
and Public Involvement in Health is being got rid of. Will you comment
on how we might get that national oversight in
future?
Elizabeth
Manero:
That is one of the other very significant
gaps in this Bill because there will be no national voice. Prior to the
establishment of the CPPIH, there was the Association of Community
Health Councils for England and Wales—the Committee must forgive
me for using its acronym, ACHCEW for the rest of the afternoon. ACHCEW
was a bottom-up national organisation, whereas the CPPIH is a top-down
organisation, so its role is to manage performance, which needs to be
done. However, we are now losing the CPPIH and we have nothing in this
Bill. Therefore, there will be LINKs consisting of no particular entity
but a group of organisations. It is not dissimilar from, and actually
it really seems to be a community empowerment network for health. You
will know that better than I. However, we have already got a community
empowerment network in the area, so I am not sure that we need a LINK
as well. What is the difference between the
two?
What is more,
forums are capable, because they are statutory entities in their own
right, of setting up their own national organisation. If they wished,
if they had
the money, they could do that. That would give them
a bottom-up national organisation able to speak for patients and to do
the sorts of things that ACHCEW used to do, namely pulling together
issues common to a number of CHCs, turning them into a national issue
and getting them addressed.
The reason that we have a
four-hour target in NHS accident and emergency units is because of the
work that ACHCEW and community health councils did on waiting times in
A and E. Sally and myself used to go every month and observe the number
of patients lying on trolleys in A and E and how long they were there.
We did that because we knew it was an issue. Hence, we now have an
improvement in service as a result.
If we do not have a bottom-up
national organisation, that sort of activity cannot take place.
However, in addition we do not have, at local level, an entity that can
say, “We have had five complaints this month about waiting times
in accident and emergency. We need to do something about that. What
shall we do? Let’s go and investigate, let’s find out
what best practice is, let’s see what’s happening
locally.” If we do not have the governance, the scale and the
resources to undertake that kind activity, we are in danger of having a
lot of talk between an awful lot of people, but I am not quite clear
what the result will
be.
I have yet to see
evidence that more people saying the same thing is of value, when you
have not managed to address what a smaller number of people are saying
already. How many people does it take to say that the hospitals need to
be cleaner or that hospital infection rates need to go down? How many
people do we need to say that? I do not understand what the objective
is in that
regard.
Sally
Brearley:
I am sure that you need no reminding that
in the original proposals for replacing community health councils there
was not a national body. Indeed, patients forums were not in those
proposals. Patients forums, the national body and the independent
complaints advocacy service were hard won during the passage of the
legislation to abolish community health councils. We seem to have gone
back to square one, in throwing away what was so hard won the first
time around, when CHCs were
abolished.
Elizabeth
Manero:
They would include a small entity, of the
right size to represent the relevant geographical area, of people who
were trained and supported, who were accountable and who had a code of
conduct that they had signed and had to keep to. There would be a
complaints process, so that any deviations from the code could be dealt
with. We need proper governance—stuff that does not need to be
invented because it has been going on for so long, such as elected
chairs, and rules and regulations. It is dull, but you do need that to
have a core activity that works.
That would be the
core of a new system, but beyond that would be links out to a wider
network of organisations. We do a lot of work with organisations such
as Thames Reach Bondway and Groundswell, which work with homeless
people. Those organisations do not know anything about health, but we
can go to them because we do know about the health service. We can
engage with them and find out what the health issues for their client
group are. That means that those
organisations can be experts in what they do and we
can be experts in what we do, and together we can add a lot
value.
To translate
that model to what we are talking about, if you have a local
organisation with clear powers—one that can go out and engage
with perhaps even organisations in the community empowerment networks
or others—which represents people who suffer health inequality
in the local area, the views of those people can be brought in to
influence the way that services are provided.
Just to give one example of
that from our work with homeless people, we involved homeless people as
advisers on patients forums’ statutory visits to A and E, so
that we could hear what the issues were for homeless people using it.
One thing that came up was the fact that if a homeless person with drug
or alcohol dependency goes into A and E with a broken leg or whatever,
they get their treatment, but they cannot be referred for
detoxification, even if they decide that they want it. They are told to
go and speak to their GP about it, but they probably do not have a GP.
There is no means of referring someone who has come voluntarily into
the health service—no way of exploiting that opportunity and
providing them with a service that they have decided they want, so they
go off. There is a waiting time, but what are they doing during the
waiting time? That is the end of
that.
That issue came
out of our visits with homeless people. We were able to go to the
hospital concerned and say, “Right, we need to set up a system
for this”. We have got funding and we are now developing a
system like that, to ensure that when homeless people get into the
health service, all their needs are dealt with. That cannot happen
unless you have us knowing about the way A and E works—having
context in the health service, governance and all the rest of
it—and those organisations that can support people who are
totally on the edge, so that you can bring the two together and add
some
value.
Sally
Brearley:
The Government say that their intentions
are to involve more people and to extend the remit to social care, and
also relate to the changing area, so that it can follow the patient
pathway, rather than just having forums attached to individual NHS
bodies. The elements of what we need to deliver that are absolutely in
place. They are patients forums, and PCT patients forums in particular.
In the existing primary and secondary legislation, there is a duty on
PCT patients forums to work together where they share interests. There
are also additional powers that PCT patients forums have, which could
enable them to be the key bodies in extending involvement and in
changing the remit to health and social care, as well as consultation.
We have got the elements in place to do what the Government say their
intentions are, and it would be much more economical to deliver it in
that
way.
Q86
Andrew
Stunell:
To follow up, if I may, would you be able to
submit a note to us that sets out what you see those steps as being?
For me, certainly, it is a little bit hazy as to what the outcomes
ought to be.
Sally
Brearley:
Yes, we could do that. The work of the
early adopter LINKs would be key to that, where existing patients
forums are acting as the key bodies in drawing the relevant partners
together.
Q87
Patrick
Hall:
I have been listening carefully and it struck me how
much common ground there is between what we have just heard from Health
Link and what Ministers are saying about what is needed for patient and
public involvement. But again, there are clearly some strong
disagreements about the mechanism and the process, which is obviously
what we need to understand in this Committee.
The Government make the
observation, as I understand it, that PPI goes well beyond patients
forums. Possibly you would agree with that because there are many
voluntary organisations out there and beyond them there tens of
thousands, millions even, of individual human beings—members of
the public who sometimes access health care or social care.
The Government have an
ambition, which I think you might share, but not necessarily through
LINKs. The ambition is to reach out, past people who volunteer to serve
on community health councils and forums—I am not denigrating
that at all—to those hard-to-reach groups of the more needy,
vulnerable and alienated people. The Bill proposes that the way to do
that is not through patients forums but through LINKs. I am interested
in how you think that can be achieved, either through patient forums or
through LINKs. It is clear that Health Link supports that ambition. We
have before us a proposal that LINKs can and should do the job. How do
you think LINKs could do that job? What powers and what resources would
be
necessary?
Elizabeth
Manero:
There is reference in the Bill
to authorised representatives for the purposes of entering, viewing and
observing NHS premises. I am not clear how many of those authorised
representatives there will be and in what way they would differ from
the rest of the members of the LINKs, but possibly there is a route
there to developing the core that I have been describing of people who
are supported and trained and have governance and so on.
I would like to add one point.
We talk a lot about involving people. Well, there is not much point in
involving them if there is no result. In my experience, which is now
about 15 years of patient and public involvement in the health service,
the relationship that you have with the health service, which takes a
long time to build, is a sort of balance. You have to have enough
powers to make it listen to you, because otherwise it will not, but not
so much power that it is disproportionate to the fact that you are not
elected, and therefore should not have that amount of power.
In my experience in Barnet,
where we had many stormy times, you started off and had to really
demonstrate that you were prepared to exercise considerable amounts of
power and make quite a lot of difficulty for a health service trust
before it would listen to you, but once you had done that, you then
found that you had a very good relationship with it. People used to
ring me at home and say, “We’re thinking of doing
this—what do you think? How can you get some people in so we can
discuss it?”
That kind of relationship takes
a very long time to build. It is not seen, and the work that we did to
inform our response to the Government’s proposals was to survey
members of patients forums and CHCs on their experience of visiting the
health service. What came through was very interesting, and I can send
this to the
Committee as evidence. What was clear was that people who are on forums
and CHCs did not go into the health service to pick holes in
everything, criticise and get straight into the local paper. They went
in there because they cared deeply about things being better. They
managed in many, many cases to secure improvements, and they
established a grown-up relationship with their local health
service.
That
relationship between any public service, but particularly the health
service, and the local community is what all these networks and so on
are trying to forge, but you cannot see that relationship. I think that
the people who have been working on developing that relationship up
until now—the patients forum members—need to remain. That
would be one criterion for this working. There has to be an
identifiable successor core to the patients forum in the LINKs set-up.
Just having arrangements, means and so on in the Bill will not do it.
They are the edges, they are the frame, but there is no picture in the
middle.
Unless we can
have that core, I do not think that there will be anything to get hold
of, anything to work or, indeed, anything to attract people. Again, I
do not know as much as perhaps I should about community empowerment
networks, but how easy is it to get organisations actively to
participate in them? However easy it is or is not, the fact that at one
end of the local authority corridor someone is doing that and that at
the other end someone is procuring another organisation to do precisely
that with another load of organisations through the health involvement
team does not make any sense to me, I am afraid. It is bureaucratic and
expensive.
In order
to achieve the objective that we all share of wider patient
involvement, that must be part of a grown-up and effective
relationship. You cannot have that relationship without powers and
without knowledgeable, well-supported people. You cannot have
appropriate involvement without the wider input that we are talking
about from the groups that support harder-to-reach
groups.
Q88
Patrick
Hall:
May I go back to the point about resources? You
obviously have direct experience in that you deal with health. I do not
know how you are resourced, but you are and therefore you have a view
about what is needed. If we were to embrace social care, too, which is
a good thing and very ambitious, what sort of resources do you think
would be needed in the area covered for a LINK, or whatever you want to
call it, to deal adequately with the
challenge?
Elizabeth
Manero:
You would need an office—people do not
relate unless there are premises and unless they can go
somewhere—because that is where they have the informal meetings
and informal network. You have to have a competent staff that can
provide the right kind of support to the secretariat and to meetings
and so on, and that knows about the health service. You have to have
member expenses and member training. Member training has never had the
attention it should have had throughout the 34-year history of this
saga. People need to be adequately trained to understand not only the
health service but the needs of people who are not there. That is
important. Those are the elements that you would need, but I cannot put
a figure on it without notice.
Sally
Brearley:
I can perhaps give you a comparable figure,
but it dates back to 2000. A previous chief officer of a community
health council in north-west London told me that the CHC budget, which
would have covered a London borough, was approximately £130,000.
That included the office, three staff and member expenses. Those are
the figures for 2000. We are now talking about extending the provision
to social care and for 2007 or 2008, so my feeling is that it would
have to be significantly more. One of the worrying things about the
proposals is that we are not told what the budget will be to support
LINKs. We understand that it depends on the comprehensive spending
review, and perhaps we cannot know the exact figure, but it would be
useful to have an indicative figure.
We must not forget section 11,
which I believe is now section 242 under the National Health Service
Act 2006 and places an obligation on the NHS to consult patients and
the public. We do not want LINKs to duplicate that. The PCT patients
forum has a duty to monitor the NHS’s performance of section 11.
That is another way in which patients forums ensure that the NHS
actively involves its users. It is quite right, of course, that they
do.
Q89
Tom
Levitt:
Sally drew our attention to page 91 of the Library
research paper when she quoted Melanie Johnson’s 2004 statement
on protection from abolition. I want to quote page 97, which cites the
Government response that “there are several fundamental
differences between PPI forums and LINKs, for example LINKs will cover
social care services as well as health, they will be established for a
geographical area rather than a specific organization, and they will
also decide locally how members will be appointed and how others will
be able to contribute to their work
priorities.”
Apart
from the addition of social care services, bearing in mind that we have
already moved to PCTs that are much more aligned with local authority
boundaries and the fact that the link with the local authority will
give democratic scrutiny through the conventional democratic channels,
I cannot honestly see how any of the good things that you have talked
about tonight that forums do cannot be done by LINKs and in spades, and
how the forums cannot merge into LINKs in future. Why are LINKs a step
backwards in your
view?
Sally
Brearley:
I would say rather that they are an
unnecessary step forward. I agree with what you are saying, but, to
change it around, what is being proposed can be done adequately by
slightly modifying the present structures. I would like evolution
rather than revolution, yet again, in the
NHS.
Q90
Tom
Levitt:
That is probably down to a legal technicality, in
that we have to abolish something before we can replace it. For
instance, we abolished the pound note but we did not abolish the pound.
There is continuity: the function and purpose will remain even if the
name
changes.
Sally
Brearley:
But the people may not. If I may go back,
there were more than 10,000 community health council members. There are
about 4,400 patients forum members. How many of them will transfer to
LINKs
when they are being told, in effect, that they are not
wanted?
Q91
Mr.
Burrowes:
To pick up on the point about transition, one of
the concerns is that those hard-working forum members—I know
some in Enfield who have done a very good job—will see the new
LINKs as lacking the teeth of the present forums, particularly in
respect of the statutory duty to inspect, which is being downgraded. We
are not talking about a change of structure. In fact, there is a
reduction in power on the fundamental issue of
inspection.
Elizabeth
Manero:
We have done a lot of thinking about that. We
are so used to the idea of an inspection right that we were horrified
when the proposal came up to remove it. We lobbied extremely hard to
get what is now in the Bill. To me, “inspection” means
the Healthcare Commission, the social care inspection provision and
national regulatory bodies such as the Audit Commission, which is
mentioned in the Bill, but I referred earlier to the relationship
between the health service and its local community. It is that
interface where inspection—if we cannot find another
word—comes into play for forums. Those people speak on behalf of
local communities of taxpayers who fund the health service and are
totally dependent on it when they are at their most vulnerable. It is
therefore appropriate for them, on behalf of patients, to see inside
the health service and talk about the things that matter.
I gave the example earlier of
homeless people. If you are lying on a trolley in A and E, you cannot
climb off it and go to another A and E where you think you will get
quicker service. Someone else has to perform a role for you, so entry
and dialogue with NHS management and practitioners about the way that
services are provided are
essential.
There is no
right in the Bill to go in, as there was under the two previous
reforms, because there is nothing to have a right—there is no
entity, which is one of the key weaknesses. LINKs are merely objects of
the duty of NHS organisations and so on to let them in. They are weak
because there is no entity. If I were in a LINK, I would not be able to
write to my NHS organisation and say that I was concerned because I had
had complaints about its chiropody service, or whatever service, and
that I would like to go in and talk to the staff. That is invaluable
when you are doing visits—you get all sorts of intelligence from
the staff that you would not otherwise get. You find out whether they
are short of money, resources or staff. It involves a relationship, and
entering and observing is to do with furthering the relationship and
making it more robust, and procuring dialogue about changes and
improvements. It is not inspection in the way that the Healthcare
Commission might inspect. It will go in with a list and ask,
“Have you got this and this?” It is not the same as
that.
Although it is
regrettable that there is not a power—there cannot be a power
because there is no entity, which is another reason why I would like an
entity—I do not have a desperate problem with the lack of the
word
“inspection”.
Sally
Brearley:
The Department of Health has tried to
reassure us that it intends that LINKs will be able to enter and view
premises where NHS services are
delivered, but probing is required during Committee stage of the Bill to
ensure that the Government give adequate commitments in respect of
their stated
intentions.
Q92
Alistair
Burt:
Our last question involved asking about your
confidence that the new arrangements would increase public
participation and involvement. My sense is that your comments have
indicated that you feel that there is a gap in what is being provided
and that that confidence may not be there among the public. Would you
like to reprise what you think might assist in closing the gap between
intention and your perception of what is actually there and what you
want to see
tightened?
In the
consultation process, did you have any explanation from the Government
why they were doing what they are doing? We have had plenty of
discussion about the what, and for the purposes of what we are doing in
the Committee, your answers have been highly illuminating in
illustrating a gap in perception between what the Government are
genuinely seeking to achieve and what you feel is out there. That will
provide a terrific opportunity for us to probe and discuss that when we
reach the appropriate part of the Bill. However, that is all about the
what. What is your perception of the why? Why should the Government
want to do what they are doing and upset what you think appears to be
working perfectly
well?
Elizabeth
Manero:
Just to pick up on that last point, I would
not say that it is working perfectly well. It has been going for three
years and it is travelling a journey that CHCs took 30 years to get to
the end of. It is going in the right direction but it has a
considerable way to
go.
As to why, I do
not know why. In our own response to “A Stronger Local
Voice”, we said that we could not see the point. It seems to me
very expensive. We are sitting here this afternoon having this
discussion, but I do not think that that is appropriate because we
should not be doing this at all. We should be leaving the system in
place and reforming and amending it. I cannot answer the question why,
I am afraid.
On
confidence, there must be much greater knowledge locally—local
authorities could certainly help with this—about patients forums
and what they do. They do a lot of very good work, and it is not known
about or understood. At national level, it is absolutely essential to
have a national body speaking for patients clearly, with authority and
independently. Otherwise, this will be seen as just a little local
activity with no real
credibility.
Sally
Brearley:
It would be interesting and illuminating to
know how many of the responses to “A Stronger Local
Voice” said that they supported the establishment of LINKs. I
know that a lot of people responded to that document, and that
situation reminds me of the discussion that we had about who had said
they wanted CHCs to be abolished. It was very difficult to locate a
significant number of people who had said that in the discussion
leading up to the publication of the NHS plan. We have the
Government’s stated intentions which, as we have said, we feel
are laudable, but I am struck by the similarity to a quotation from
Bertolt Brecht, which I am sure many of you are familiar with, that the
people have “lost the
confidence of the government” and the Government have decided
“to dissolve the people and elect
another”.
We
are very awkward customers, us patients forums people, and us CHC
members were very awkward as well. But hey, that is the nature of
democracy. You might not like what we say, but we are going to go on
saying
it.
Q93
Alistair
Burt:
You will be delighted to hear that, on the
Conservative Benches, la lutte continue. We will certainly be putting
forward some of the things that you said. On the consultation on
“A Stronger Local Voice”, do you think it would be
helpful if the submissions to the exercise were made public? I believe
that they have not yet
been.
Sally
Brearley:
Yes,
absolutely.
Elizabeth
Manero:
Yes. I cannot see why they would not be. I
was not aware of that. It is very
odd.
Q94
Tom
Brake:
You may have been intending to supply us, in
response to Andrew Stunell’s request, with a document setting
out what would make LINKs work. It would be useful if you could include
in that the key steps that you would take if you wanted to convert your
present structure of forums into LINKs and what three or four steps you
would have to take to achieve
that.
Sally
Brearley:
Sorry, was that a question or would you
like us to supply
it?
Sally
Brearley:
Yes. I think that is exactly what the early
adopters are doing at the moment, and they are learning from
that.
Q95
Alison
Seabeck:
Two questions. You were very helpful at the
beginning, setting out a little bit about your organisation. You did
not say how you are funded, for example. Are you a membership
organisation?
Elizabeth
Manero:
No, I did not say, I beg your pardon. We are
commissioned by different bits of the NHS and the Department of Health
and others to undertake projects, project work and patient involvement
work.
Q96
Alison
Seabeck:
That is very helpful. The second thing that has
been bothering me about your evidence is that you have repeatedly said
that your members are being told that they are not valued and that we
want to get rid of them. Who is saying that your members are not
valued?
Elizabeth
Manero:
It is not my
members.
Alison
Seabeck:
Well, members of the forum. Who is saying that
they are not valued and therefore will not have a potentially important
forward
role?
Elizabeth
Manero:
As I explained earlier,
actions speak louder than words, and because the organisations of which
they are members are being removed and there is nothing in the Bill
that guarantees their transference to the new organisation, I think
that that is what counts.
I am not saying whether there have been letters to the Ministers or to
forum members this time. I do not know what has been said. I am judging
it by the actions, and from the contact I have had with forum members,
that is how they are judging it.
Sally
Brearley:
In a sense, you have repeatedly said that
the forums are going to be done away with, they are not going to be of
use and they are not valued. I find that slightly of concern. I suspect
that if the Minister of State for Health Services, the right hon.
Member for Doncaster, Central (Ms Winterton) were here, she would say
that that was simply not the case. She would say that they are valued
and they will have a forward role, and because of the statutory
requirement in the Bill to get rid of the current structure and replace
it, that does not necessarily mean that those excellent people will not
be encouraged to participate in the
future.
Sally
Brearley:
I notice that the Minister is
sitting behind
me.
Sally
Brearley:
No, but I would like to acknowledge the
fact that we have had, as forum members, letters saying that we are
valued. What I would like, however, is an assurance—if the
Minister or one of her colleagues can give it during the progress of
the Bill—that existing patient forum members can transfer
automatically to LINKs. As Elizabeth said, actions speak louder than
words. I would also like to mention that existing patient forum members
have been checked by the Criminal Records Bureau, which is a costly and
time-consuming process. To take on those members who have already been
through that process so that they would be able straight away to
deliver the inspection role would be great. Therefore, an assurance
that patient forum members can transfer would do a lot to answer our
worries.
Q98
Mr.
Woolas:
Do you see any benefit in enhancing the
work that you do for local authorities, and particularly for elected
councillors? How do you think that we could better join that
up?
Elizabeth
Manero:
The role of overview, scrutiny and health is
developing very well in many areas. Unfortunately, however, it sits at
the town hall. If there were better practical links—the links
are there legislatively speaking—between patients forums, the
patients forums could be the eyes and ears of elected councils inside
the health service. They could also help to bring in health issues that
might be relevant to the well-being power and other functions of local
government that are relevant to health. They could assist with bringing
in the views and perspectives of people with health inequalities to
that work. So, I think it is twofold really. They could be the eyes and
ears of the scrutiny committee inside the health service. That would
then act as a counterweight to the NHS. In the scrutiny committee, the
NHS gives evidence and it is
quite difficult to get anyone else of similar
weight, so that would work very well with that. On the role in health,
they would have a contribution to make as
well.
Elizabeth
Manero:
I think so, yes, because there is the link
between LINKs and scrutiny committees when it comes to making
referrals. There is a plan to match the social care referral power in
the Bill with the existing health power to make them the same. I think
that that is very welcome. That opens up that channel of communication.
On the health side, I am not so sure, because the LINKs relate
exclusively to social and health care services, and their providers.
Their role in health is less distinct than the current situation with
patients forums, so I think that that is a weakness.
Sally
Brearley:
The majority of the local authority
scrutiny committees to which I have spoken in the course of my work
were worried about the proposals to abolish patients forums, because
they regard them as their eyes and ears. The fact that patients forums
have the power to enter and inspect, and that they are often aware of
the issues concerning patients in their area, has been extremely
valuable to scrutiny committees. Patients forums give the committees
the information that they need to decide which services they are going
to scrutinise, and the confidence that they are picking up the views of
the population. Patients forums have been very welcome.
Scrutiny committees were
slightly reassured when we were told that LINKs would have the power to
enter and inspect, but they are worried about the potential gap between
the abolition of patients forums and the setting up of LINKs. That
seems to be the case from what we have been told about the transition
process.
Q100
Andrew
Stunell:
Has the experience of PPIH members in London been
the same as the experience of people in the north-west? In Greater
Manchester, PPIH members have received two letters: the first telling
them that their work was highly valued and that it would come to an end
this month; the second, a week or two later, saying, “Whoops.
Actually, we would like you to keep going until October.” Would
you like to comment on the impact that that is likely to have on
people’s willingness to
continue?
Sally
Brearley:
Yes, these are confusing times. It is a
testimony to patients forum members that so many of them have been
prepared to go on, and are hanging on in there. The timetable of
transition depends on the legislation, so it is inevitable that there
is some uncertainty. As patients forum members, we may get subsequent
letters that again alter the timetable. The Department of Health tells
us that the plan is for forums to be abolished in December 2007 if the
legislation goes through this Session, for CPPIH to continue until
March 2008, and for LINKs to be set up sometime from January 2008
onwards. There seems to be a gap, so I am sure that we will get further
letters about our membership.
Q101
Tom
Brake:
Notwithstanding the gap, would you cast your mind
back to the abolition of the CHCs, and perhaps tell us what sort of gap
or loss of effectiveness there was from the point of abolition through
to you feeling confident that the present structure was working
effectively?
Sally
Brearley:
I think that transition is not about one
set of organisations ceasing on one day and another coming into
existence the next. I think that we lacked a managed
transition.
One of
the great losses was the loss of CHC staff. The Minister at the time
gave assurances to Parliament that there would be a role for CHC staff
in the new structures. Unfortunately, it was not within his remit to
deliver that—it was up to the CPPIH which, as we know, went with
a different method of providing support, which was to contract it out
to forum support organisations. There was a big gap, in which time any
remaining CHC staff would have been few and far between, even if they
had wanted to seek employment with the forum support organisations.
There was a big gap in the support being offered. As Elizabeth said,
there was also a big gap in terms of getting in place basic things such
as governance arrangements and standing orders for how forums should
operate. Many of the new recruits to patients forums, people who came
in very keen to work in patients forums, left because it was such a
shambles in the early months. We need a carefully managed transition.
It was sad that in the transition from CHCs to patients forums we lost
so much that was good about CHCs.
Elizabeth
Manero:
May I answer as well by giving an example?
Your previous witnesses referred to the level of deficit in the health
service in London and cuts in services. Without patients forums, how
will any of us know the day-to-day effect of those cuts? How will a
debate about whether or not those cuts were advisable be informed with
a patient’s perspective? With the wholesale removal of patients
forums in London which, as we speak, are monitoring the health service
on our behalf and getting evidence on our behalf of the effects of
those cuts, those services will be gone. The particular situation in
the health service now with cuts happening is more serious than it was
when CHCs went. That significant risk must be
considered.
Elizabeth
Manero:
Yes, but they will be setting up. They will
be recruiting and training people. They will be telling them where
their local hospital is. That process can take six to nine
months.
Elizabeth
Manero:
No, absolutely. I am saying that the timing
of the transition, such as it is, is extremely unfortunate from the
patient’s point of view. That is another reason to look
extremely carefully at the transition
arrangements.
Sally
Brearley:
Also in terms of that, who are we expecting
to set up the LINKs, if indeed it will be a body? It is the people who
the local authorities will contract with to provide the support. I
think that it is termed H—the host—in the Bill. The host
will establish the LINKs. We do not know who the hosts will be. What
will they know about establishing a LINK? Who will they choose to be
the LINK? Will they do it by virtual means, as the provision outlines
under the Bill? It states that it may be a person or persons or it may
be done by “any other means”. So it will not necessarily
be a body, even when it is established. I have worries about the host
organisation setting up the LINK. How will it know what to do? What
expertise will it have? How long will it take to go about
it?
The
Chairman:
That concludes our questions. Thank you very
much. On behalf of the Committee, I should like to thank you for your
attendance today and for your
witness.
Further
consideration adjourned.—[Jonathan
Shaw.]
Adjourned
accordingly at twenty-seven minutespast Six o’clock
till Thursday 1 February at half-pastNine
o’clock.
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