Examination of Witnesses (Questions 184-199)
MR PETER
GILROY OBE, MR
PAUL CARTER,
MR DAVID
PETFORD AND
COUNCILLOR MIKE
FITZGERALD
10 NOVEMBER 2008
Q184 Chair: Welcome, gentlemen. I think
you were all sitting in the back in the previous session, were
you? So you have heard some of issues we have gone round. Before
we start, can I just say how interesting it is that Maidstone
chose to set up a special scrutiny committee to answer the questions
that the Committee posed in its evidence. It is a very interesting
example, I think. We are grateful for the fact that you took this
extremely seriously, and obviously we too take very seriously
what local councils say to us.
Councillor FitzGerald: It went
through cabinet and then through full council before it came to
you, so it is a good example.
Q185 Chair: Thank you very much.
Obviously since there are four of you, on the whole, we would
prefer it if it is only one of you from each council that answers
each question, and do not feel obliged for each council to answer
each question. But we will kind of take it as we go. I would like
to actually start on the issue of the use of existing powers with
separate questions to each of you in fact, so starting with Kent,
because as I understand it Kent seems to pretty adequately use
all the powers that it has already, and is asking for some more.
Do you nevertheless expect ministers generally to devolve powers
to councils when, unlike yourself, most councils seem not to be
using all the powers that they have?
Mr Carter: Thank you, Chair. I
would like to think that, as you are suggesting, Kent is taking
full advantage of its well-being powers, and also its powers as
an excellent authority to do things that authorities that are
not classified as excellent are not allowed to do, like running
trading businesses, where we are involved in a number of innovative
entrepreneurial activities which add substantial income to the
overall County Council budget of some £2.2 billion a year
in providing to enhance and run frontline services for the 1.35
million residents that we represent. Yes, of course, and you will
have read from our submission that we are very keen, and have
an appetite to take up significant additional powers. We are much
encouraged by talk about post-16 funding, LSC funding coming to
Kent County Council; we believe we have an enormous amount to
offer in welfare dependency reduction, based on a significant
amount of innovation that has gone through the Supporting Independence
programme, which was set up by Lord Sandy Bruce-Lockhart in 2002,
and our educational transformation in preparing young people for
employment, both through apprenticeships and sustained employment.
So a whole raft of issues that we would like to have enhanced
powers over. As I say, specifically, we believe we have an enormous
amount to offer in the debate about welfare reduction, particularly
for the younger generation of people entering employment.
Q186 Chair: So you still have not
answered the question though: do you think, given that most councils
do not use all the powers, that it is reasonable to expect ministers
to give councils generally more powers still?
Mr Carter: I do generally believe
in earned autonomy, and I think we do not necessarily have to
apply a one size fits all policy, we have a completely different
landscape of local governments, and I am interested to see you
have cities, you have two-tier authorities, you have London boroughs
that you are talking to today. The landscape in local government
is highly complex. But why do we have to have a one size fits
all? Government could say to us, there you are, Kent, we like
your ideas, we like your innovation, let us try it for five or
three years and review whether the outcomes for the residents
of Kent are better or worse than they would be from a centrally
managed, centrally administered direction.
Q187 Chair: If I can move to Maidstone,
I think in your submission, you were making the argument, I mean,
you recognise that councils including yourself do not necessarily
use all the powers that you have. Would you like to tell us why
you think you have not used all the powers that you have? And
indeed I suspect your relationship with Kent.
Mr Petford: Yes, indeed, Kent
are a very important partner and we work well with Kent. I think
the question is not just about powers, I think there is a difference
for me between powers and duties and responsibilities. I think
there are strong arguments to increase duties and responsibilities,
in fact move duties and responsibilities, so the complexity of
councils at different levels in different areas doing different
things, but I think in terms of powers, the legal power to actually-whether
you can actually do something is quite different to that. I think
currently, with the well-being power, which is clearly the power
of first resort, not last resort, first resort, that does open
up quite a wide range for most councils to do lots and lots of
things. So from that point of view, I do not think powers for
me is the issue, I think it is more about whether we should be
involved in other areas and whether or not our duties and responsibilities
should be extended into other areas.
Q188 Chair: In your submission, I
do not think it would be too strong to say that you feel that
Kent County Council gets in the way of you exercising all the
powers or freedoms that you would wish. Do you want to be more
specific?
Mr Petford: Well, I think we are
both top performing councils, and we are both very ambitious councils,
and we are both keen to make a difference. So because of that
vibrant energy to try and do things better, quicker, smarter,
sometimes yes, we get in each other's way. I do not think it is
just Kent County Council, it is probably Maidstone just as much
as Kent County Council, but at times, we get in each other's way,
because I think with a two-tier authority, sometimes there is
confusion on who does what and all the rest of it, and perhaps
that is an area that could be looked at. Indeed, my own council
has the view that a unitary structure would be preferred, but
then there is a long debate, and one that my council has not finished
yet, what size should that authority be? It is all about size
rather than by the merits of who should govern—
Councillor FitzGerald: Quickly,
our evidence did say the powers were not being used because they
were risk averse and created by inspections and constant measuring
and so on, so I suppose it is a nervousness to move into a field
that does not then get carried through. So what they want is the
greater-we have the powers to do it, what we want is the freedom
to enact it.
Mr Gilroy: Chair, if I can just
add one point about health, it did come up in the last discussion,
the health economy spending is about £1.2 billion in Kent,
and it does seem to me that outside of scrutiny, there does need
to be a new dynamic about how we work with the health economy,
particularly now we have the GP contracts out, we have a whole
range of things happening. For us, it is really important that
in terms of, for instance, assessment costs, I would like to take
more power on actually making judgments about our global assessment
costs, which seem to be getting bigger within what I call the
systems of health and social care, and I do not think we have
enough power —
Q189 Chair: Sorry, can you just explain,
what do you mean by assessment costs?
Mr Gilroy: If you look at the
way we all operate, we all operate on the basis that the general
public, when they need healthcare, much of healthcare will touch
social care, and therefore people need assessments. We have what
we call single frameworks for assessment, local government and
health, but the truth is it has become so convoluted, so confused,
that when I was going out visiting clients, the general public,
three or four months ago, the sort of message you would get is
everybody is really nice, but everybody wants to do assessments,
nobody wants to do the washing up any more, it is that sort of
theme. From a commercial point of view, from a business point
of view, I would like to see much more dynamic interplay between
what those gross costs are, because if you spend too much money
on clinical assessment, you are wasting a lot. If you suddenly
find that those costs are getting into 12, 14, 15% of gross expenditure,
somebody needs to be able to look at that independently, not an
individual silo, and that is the point I am making. I think local
government could have a major part to play, added to scrutiny,
on that issue with some measure of power, that would have the
power to—not direct, but the power to shape and influence
much more dynamically than we can at the moment.
Q190 Chair: Just a practical point,
how many PCTs are there in Kent?
Mr Gilroy: Two.
Q191 Chair: Only two? So each would
cover several districts presumably.
Mr Gilroy: Yes.
Q192 Sir Paul Beresford: So you,
in effect, like our previous witnesses, would prefer to keep the
core of the N in the NHS, you want to look at it but not control
it?
Mr Gilroy: The NHS is a massive
system, and what you need to work out between local government
and the NHS is what bits of those services would be best, as it
were, managed globally. I have always said, having worked in the
Health Service, that primary health is much more akin to local
government and community services, that is a personal view as
a chief executive. If I had a view, it would be that primary health
should be much more accountable to local government in its commissioning
function than acute trusts or foundation trusts.
Q193 Chair: So the question we asked
previously was: how exactly would it be accountable?
Mr Gilroy: I would do it through
the commissioning part. Coming back to the earlier questions about
council rates or coronary heart disease, et cetera, I do think,
to be honest, if you look at Europe, if you look at the US, we
do tend to be overcentralised in the UK. I mean, there are things
that you could decide as a government and say, "These things
we need to do better on", cancer rates might be that, it
may be other things, but it seems to me that the discretion should
be much more open to having difference. We have got into the lottery
postcode in a way that it is becoming now politically incorrect
to even talk anything against it, and I feel there needs to be
a bit more pragmatism about local communities' different needs,
we should in commissioning terms have much more power to determine,
set against what the Government's broad policy objectives are.
I think at the moment, the Government has too many policy objectives
and too many targets, we need to reduce those and give local government
much more say in how that is managed.
Q194 Anne Main: Just on health, before
we leave that and go on to what I was going to ask you, could
I just ask you then, would you be in favour, for example, in terms
of raising local tax, say, for example, having a local health
insurance?
Mr Gilroy: Yes. You know, we are
not alone in this. Europe has the same problems, and I cannot
see, in certain thresholds, if a local community decides it wants
to have something special in its healthcare, and that is what
it wants, why should we not say yes? We do it in other parts of
our business.
Anne Main: So then would you stop someone
from a neighbouring authority using the special thing?
Q195 Chair: Mr Carter, you seem to
be slightly excited by this contribution.
Mr Carter No, but it all depends
to a degree on the distribution mechanism, the needs-led analysis
in the way funds are distributed for the health economy, the same
in local government. At the moment, we do not have clarity, all
I see is fog in how a revenue support grant is distributed around
the country, and how the health funding is distributed. For example,
Islington, per resident, gets about £1,950 per resident.
Kent on average for both PCTs gets about £1,100 per resident.
If you looked at the index of multiple deprivation in East Kent,
it would match or rate anything in the North or North East of
England. Yet where is the transparency and the needs-led allocation?
It comes back to Lord Bruce-Lockhart, when he was chairman of
the LGA, suggesting that we have an independent body that looks
at the needs-led analysis and statistics before the cake is carved
up between authorities or between PCTs, and before we start having
supertaxes and supercharging over and above the national allocation,
let us look in a common sense pragmatic way at the way existing
resources are distributed around.
Q196 Chair: Can I just clarify, Mr
Carter, we may have it wrong in our briefings, but we think that
Kent County Council rejected the case for establishing an independent
commission to oversee local government finance—on the grounds
it would undermine the principle of accountability of central
government to its electors, indeed.
Mr Carter: That is something I
have never subscribed to. I have always totally supported Lord
Bruce-Lockhart in his position on, as I say, having a national
body.
Mr Gilroy: As I understand it,
I think the issue was that if there was going to be a commission
to make these judgments, it should be a national commission, not
a sub-regional commission. There was a question of whether these
structures are going to be further quango land, development of
new commissions in the nine regions. We say if you are going to
have a commission, just have one, do not have more costs.
Q197 Chair: Just for clarity then,
so Kent County Council would be in favour of an independent commission
to sort out distribution if it were national? Meaning England,
presumably.
Mr Gilroy: Yes.
Q198 Anne Main: Can I just not leave
the postcode lottery? I am sorry, we went off at a slightly different
tangent, but you did say you believed an area should be able to
come up with a special project, maybe a health project; how would
you not be then competing with other areas in terms of if they
want to use your project, or would you say it is local things
for local people?
Mr Gilroy: We have a bit of mythology
already about this question. The Primary Healthcare Trusts across
the country are all actually doing different things, and there
has been example after example, whether it be to do with drugs
or whether it be to do with services, we are talking about human
beings providing services. There will always be difference. I
do not think there will be a rush; there would be some of that
going on probably in the country ultimately, but I think in the
end, what you would be providing is a much more coherent—if
I could say one other thing, the more you decentralise, and I
have found out in my own career, the more you decentralise: for
instance, we now give purchasing power to citizens in Kent, big
time, you have your own purchase card for your own services. When
we started out on that journey, we were told this was going to
be terrible, it was going to be fragmented, and the public would
not use it. The public love it, they are more frugal with the
money we are spending, we are controlling our money more effectively.
So my argument is the same in healthcare, the more you decentralise,
the more you give freedoms, citizens will be better, they will
be healthier, and it will be less driven by what I call the centralised
notions that you can run everything from London. I think it is
one of the dilemmas the Government have had, and the previous
Government, if I am honest, and I just think we need to change
that.
Chair: Can we move on to local government
finance?
Q199 Mr Betts: You have both put
forward ideas about how you would like to create greater financial
freedom, including relocalisation of the business rate. Is that
not because you are both quite wealthy areas and you think you
would do quite well out of it?
Mr Petford: First of all, I think
if you look at Maidstone, I think we collect something like £35
million, and then we are allocated from business rates, and I
think from central government we get something like £5 million
back. So that does not seem very appropriate, certainly from my
members' point of view.
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