The delivery of local police,
health and healthcare services: the role of local government
67. During the course of our inquiry, we asked
whether local government's role and influence needed to be strengthened
in relation to local policing and health services. The answer
from local government, and local government think-tanks, was "yes".
Sir Richard Leese, told us that "we can scrutinise, so we
can call in people from the PCT and ask them what they are doing
and say 'that is not very good', et cetera. What we cannot do
is then effectively say, 'No, you are going to have to change
what you are doing because you are not meeting the objectives
for, in our case, Manchester.'"[76]
Birmingham, Gateshead and Kent similarly pressed for the ability
to direct the local delivery of primary healthcare. With regard
to local policing, Westminster was adamant that there was an accountability
gap with regard to local policing, "a pretty disconnected
picture" even though "they have come a long way in the
Met."[77] Camden
highlighted instances where the council and police were working
to competing targets, such as entrance into the youth justice
system where "our target is to get it down and the police's
target is to get it up."[78]
68. Similarly, the think tanks Local Government
information Unit (LGiU) and New Local Government Network (NLGN)
argued that both the police and primary care trusts (PCTs) are
insufficiently accountable to local people, the LGiU stating in
its written evidence that:
In practice, services such as police and PCTs are
primarily accountable to Whitehall; this lack of direct accountability
has an immediate impact on the ability of these services to respond
to local priorities and meet local concerns.[79]
In oral evidence, Andy Sawford, Chief Executive of
the LGiU, further observed that in polls they had commissioned
"both the public and councillors feel that there should be
stronger accountability at a local level around policing and healthcare.
Policing comes out as the number one issue that people want a
say over in their community, and one where there is least opportunity
for them to do it."[80]
69. There was a similar amount of consensus as
regards how to improve the situation, with a number of different
local government and think-tank witnesses advocating a model where
local authorities would commission local health and policing services
from the local NHS or police authority. For example, in oral evidence
Cllr Merrick Cockell, Chair of the local authority representative
body London Councils, explained that:
We think the way ahead is for commissioning to be
carried out along with the budget for level one policing, particularly
neighbourhood policing, in other words to be joined to the budget
that local authorities spend, which is often quite substantial
these days, pool those together and then for the local authority
to commission the borough commander to deliver level one policing
in our area. [81]
He also confirmed that "the same would apply
to health. Certainly the London Councils model is that it would
apply to PCTs, that we would be the commissioners for local health
services in our area."[82]
Andy Sawford observed at the same oral evidence session that "we
developed a similar model. [
] commissioning is the key and
how you use local commissioning, what an opportunity that presents.
It is the key to innovating, to getting people involved."[83]
In written evidence, the Association of North East Councils felt
that a commissioning model "under which the local authority
would hold the budget for, and be responsible for the commissioning
of, local health and policing services" would "be a
bold innovation but it would take us a long way forward in securing
democratic accountability", and suggested that the model
be trialled "in the first instance in a few authorities."[84]
70. Advocates of the commissioning model recognised
that its implementation would be challenging, not least because
local authority boundaries did not always match local health and
policing boundaries. They felt though that, given the potential
benefits for local service delivery and local democracy, any obstacles
could and should be overcome. With regard to the boundaries issue,
it was suggested that local authorities working in partnership,
possibly within a Multiple Area Agreement (MAA), would offer a
potential solution. Cllr Merrick Cockell observed that:
we would from our own free choice agree to form groupings
to do it [commissioning]. It may not be necessary or ideal to
have 33 of everything in the case of London. There may be very
good reasons, again without changing the structure of local government,
to ally together with neighbours or others to achieve certain
things better.[85]
Anna Turley similarly emphasised the need to "think
about the appropriate level for all the kinds of services we deliver",
and felt "really encouraged"[86]
by the multi-area agreement process.
71. Finally, advocates of the commissioning model
stressed its advantages over an alternative model whereby commissioners
of local health or policing services would be directly elected
by the local people. At the time of our inquiry, this model was
being floated in a Home Office policing Green Paper, From the
neighbourhood to the national: policing our communities together.
Published in July 2008, it proposed the establishment of local
directly elected Crime and Policing representatives (CPRs), who
would be responsible for ensuring that the police were tackling
the priorities that concerned local people most. Our local government
and think-tank witnesses were more or less unanimous in arguing
that such a model would actually undermine local democracy. The
LGiU, in its written evidence, was clear that the model as articulated
in the Green Paper "has the potential to undermine the progress
in joined up government that have been made within local strategic
partnerships."[87]
The LGA, in its published response to the Green Paper, argued
that directly elected crime and policing representatives would:
undermine partnership working between police and
councils
make it more difficult for local people to decide
who is responsible for reducing local crime and anti-social behaviourin
effect councils would no longer have a significant role in holding
the police to account.
waste scarce resources and create substantial new
financial and administrative burdens for police authorities.
have no more flexibility to address local crime priorities
than police authorities currently do.
remove a significant amount of local spending from
local authority influence.[88]
Similarly, in oral evidence Anna Turley felt that
the principle of a local say in local policing was not best served
by "the creation of a new elected representative on an authority
which most people have very little awareness of, and which perhaps
not only duplicates some of the role of the local authority but
may start to fragment policing from the wider place-shaping agenda."[89]
Lancashire County Council observed that "recent suggestions
that policing or health should adopt separate democratic mechanisms
to ensure public accountability are misguided," adding "In
addition to creating wasteful taxpayer expense, directly-elected
health or police boards could confuse voters, especially in three-tier
areas like Lancashire."[90]
It is clear from the above that it is not just the specific Green
Paper example that the local government family is opposed to;
it is opposed in principle to directly elected policing and health
representatives because they believe they would undermine local
government and hence local democracy.
72. We put the local government case for increasing
their powers over local policing and health to the Home Office
and the Department of Health, and were struck by the extent to
which they were opposed to it. Local councillors do currently
serve on Crime and Disorder Reduction Partnerships (CDRPs) and
on police authorities (commonly 9 out of 17 members of a police
authority are councillors). They do, therefore, have input into
local policing priorities. They are not, however, the leading
voice, lacking as they do control over local policing resources.
As well as the contentious CPRs proposal discussed above, which
the Government has since announced it will not proceed with at
this time, the Policing Green Paper also advocates more partnership
working, bringing together local policing with the broad range
of local servicesprovided by local councils, housing associations
and othersthat contribute to community safety. Whilst it
sees a leading role for local government in crime prevention as
part of its wider responsibility to support communities, this
is still some distance from the leading role in many aspects of
local policing advocated by many of our local government witnesses.
It was therefore unsurprising that the Minister of State (Policing,
Crime and Security), Mr Vernon Coaker appeared somewhat taken
aback when we asked for his response to the proposal that neighbourhood
policing should move to local authorities, who would become commissioners
for these police services, responding:
I do not know about local councils controlling the
police but certainly what we would want to see is the strengthening
of the partnerships that already exist.[91]
He appeared more comfortable envisaging local authorities
in purely supportive crime prevention roles, observing that:
we see the involvement of local authorities in a
crime reduction role, a role which includes all the various aspects
that lead to communities feeling safer and indeed tackling crime.
This is particularly important if you look at local councils in
terms of what they do with respect to graffiti, with respect to
litter, with respect to lighting, with respect to council housing.
All of those matters are fundamental to the importance of delivering
safer communities, but on their own are not necessarily connected
strictly with policing.[92]
Later on in the evidence session, he commented that
"I think local councillors, local authorities, have a very
real role to play through the CDRPs with respect to the broad
community safety agenda, of which policing is a part."[93]
73. The implication of his comments, we felt,
was that most aspects of local policing needed to remain firmly
under the control of the Home Office and the police themselves,
that local policing ultimately needed to be left to the professionalsalbeit
with the proviso that the professionals were willing to negotiate
local priorities under the Local Area Agreement process. The differencesubtle,
but profoundis that whereas under current arrangements
the professionals have the whip hand at the negotiating table,
were local government to have commissioning powers, the balance
of power would move substantially in their favour.
74. Under current arrangements, local authorities
have even less influence over local health priorities than they
do over local policing. Whereas councillors are at least guaranteed
a place on policing authorities and CDRPs, they have no equivalent
automatic right as councillors to sit on the local NHS equivalent
structure, the Primary Care Trust (PCT). Under the terms of the
Health and Social Care Act 2001, local authorities have the power
to scrutinise local health services, and local NHS bodies are
required to co-operate with local authorities. However, this still
places local authorities at some distance from the decision-making
process for the delivery of local health needs and health care
services. The Department of Health and CLG published a joint document
in December 2007Delivering health and well-being in
partnership: the crucial role of the new local performance frameworkwhich
did place further emphasis on PCTs working in partnership with
local authorities to determine the health and well-being needs
of the local community, and reflect them in the LAA. In some areas,
local authorities and PCTs have agreed locally to pool budgets
and commission some health services jointly. However, PCTs have
a range of priorities to meet, and local government witnesses
have suggested that in the main the NHS remains likely to prioritise
national targets over locally agreed targets.
75. Our oral evidence session with the Under
Secretary of State (Health Services), Ann Keen MP certainly provided
evidence of the 'centre over local' attitude of the Department
of Health. We asked whether there were any circumstances where
the Department of Health would be willing to drop national targets
in favour of other locally-set priorities, and were told very
firmly "no".[94]
Whilst the Under Secretary was quite prepared to encourage greater
local consultation by the PCT, and to support scrutiny of the
PCT by the local authority, she saw no need for any more fundamental
change, arguing that "the NHS does not need further reorganisation.
It needs a period of stability [...]".[95]
When we suggested that replacing the current members of the PCT
with elected councillors would not require a change of structure
or organisation, she argued that "people want Parliament
to be accountable for the health spending of their local area",[96]
echoing one of the key challenges to changing the balance of power
between central and local government (public perceptions) that
we identified earlier in this report. This does however lead to
a situation where the centre becomes accountable for every local
health decision, which is not a comfortable position for a Minister
to be in. When put under pressure, such centralism cannot hold.
Unsurprisingly, the Minister shied away from the implications
of her stance, asserting that "people have to take that responsibility
locally as well."[97]
When pressed on how an appointed PCT could in practice be held
accountable locally, she had to accept that the main line of accountability
actually led to the Chief Executive of the NHS.[98]
76. Jo Webber, Deputy Director of the senior
managers' representative body the NHS Confederation, provided
a further glimpse of the NHS's centralist mentality, which is
clearly not limited to Whitehall. We asked whether she would
feel comfortable with a model where local councillors had the
responsibility to commission health services at local level instead
of the current arrangements through PCTs. She replied that "what
we would be comfortable with is, to a certain extent, what we
have already."[99]
She did see further opportunities for joint commissioning at the
preventative end of the health spectrum, but argued that "maybe
local authorities might not want to get involved in commissioning
very specialist, heavy end, regional or national specialty services",[100]
and did not accept the arguments in favour of sole commissioning
by local authorities. We were left with the impression that,
as with the Home Office and police, the Department of Health and
the NHS felt that, ultimately, the professionals knew best and
should be left to make the most important local health decisions.
77. We are concerned that neither the Home Office
nor the Department of Health, on the evidence put before us, are
ready to allow local authorities a real role in local policing
and health and healthcare services. Despite recent changes that
have brought in greater transparency and more consultation, the
balance of power remains very firmly in favour of Ministers and
the policing and health professionals over locally elected politicians.
Whilst we acknowledge that there is much useful joined-up working
going on in some aspects of local policing and health services,
involving some joint commissioning, it is by no means sufficient
to alter the overall balance of power. The picture is particularly
stark with regard to the NHS, where it is not even standard practice
for local councillors to sit on PCT Boards. Moreover, hospitals,
particularly where they have Foundation Trust status, also remain
powerful brokers whose Boards have no requirement to include local
authority representation. Our
concern is twofold. First, local policing and health care services
remain insufficiently accountable to their local populations.
If local councils commissioned these local services, local accountability
through the ballot box would be much stronger. Second, at present,
local councils are unable fully to assimilate local policing and
health and healthcare services into their strategic vision for
the locality. So long as two such important local servicesarguably
the most important for most local peopleremain outside
its scope, the full benefits of an empowered, autonomous local
government cannot be realised.
78. On balance, we are convinced by the local
government case of the potential for local people to benefit if
local authorities were able to set local priorities for local
policing and health matters.
In principle, we can see no reason why most
aspects of local health and policing should not become the responsibility
of local government. We can see merit in local authorities or
sub-regional partnerships taking on sole responsibility for many
local health commissioning priorities and, via sub-regional partnerships,
for many local policing priorities.
We recommend, therefore, that the Department of Health and Home
Office work with CLG to establish a local authority commissioning
model for local policing and health and health care. As a first
step, we recommend bringing forward pilot projects in localities
where there are matching boundaries and where some joint commissioning
already takes place.
Developing current frameworks
79. As well as considering the scope for granting
local government additional powers, during the course of this
inquiry we have also considered the scope for developing current
frameworks in a more devolutionary direction: the potential for
further incremental change. From the evidence we have received
during this inquiry, local government and other stakeholders have
given a cautious welcome to the frameworks introduced by this
government. The Local Area Agreement (LAA) between central and
local government in a local area is at the heart of this framework,
and a number of witnesses felt that it was a positive development.
For example, Stephen Hughes, Chief Executive of Birmingham City
Council told us that LAAs "are a massive step forward",[101]
while Sir Richard Leese, Leader of Manchester City Council, told
us that the LAA "is something that we think has real value".[102]
We noted with interest too, given that the NHS is a key stakeholder,
that Jo Webber, Deputy Director of the NHS Confederation, was
also supportive of LAAs, telling us that "in principle, yes,
it is absolutely the right way to go in terms of bringing together
targets where everybody has a role to play in delivering good
outcomes for the local community."[103]
80. LAAs are of course still quite new, and we
heard concerns expressed that the LAA process remained too 'top
down' rather than a genuine negotiation between equal partnerseffectively
hindering the development of more tailored local solutions. Warwickshire
County Council wrote that "the fact that LAAs have 16 mandatory
education indicators speaks for itself," asking "How
do we encourage people to engage in local democracy and empower
communities to believe they can make a difference when there is
this level of prescription?"[104]
Councillor Jill Shortland, Leader of Somerset County Council,
told us, with respect to the LAA, that "the direction that
we get from central government is quite clear and harsh."[105]
Councillor Susan Williams, Leader of Trafford Council, observed
that "there was no way of being able to choose your own local
set of 35 [targets]. It came from the government shopping list."[106]
Jules Pipe, Mayor of Hackney, further felt that some central
departments were inclined to turn the screw after the 35 targets
had been agreed:
[
] There were some really hard tussles, particularly
on NI25, the one on preventing violent extremism. The pressure
that people came under from the Home Office to include that was
quite extraordinary.[107]
Research undertaken by the NLGN adds further weight
to the suggestion that the LAA process remains too "top down".[108]
81. There is nevertheless hope for the future
of LAAs as a genuinely devolutionary development. Telford and
Wrekin Council expressed a cautious optimism which seems appropriate
in this context, writing that "a revised and refreshed LAA
model still has the potential to be a bespoke negotiation mechanism
through which there can be a balancing act and a focusing of key
national and local priorities".[109]
The challenge
now, for local government, central government and other local
strategic partners, is to ensure that the LAA process develops
as a true partnership with sufficient flexibility to register
local priorities as well as minimum central requirements. In
particular, we look forward to seeing more pooling of resources
under the LAA, and for those resources to come more equally from
other partners as well as local government.
82. A number of witnesses were also taken with
the potential for Multi Area Agreements (MAAs) to enable local
councils to pioneer local solutions at the sub-regional level.
In their written evidence, NLGN argued that "the roll out
of MAAs from 2008 onwards promises the prospect of a new functional,
viable and organic tier of government that operates at the correct
spatial awareness to solve cross-boundary challenges such as skills,
transport and employment."[110]
Written evidence from London Councils saw the MAA model as a means
for devolving commissioning powers to local authorities where
boundaries (eg for policing and health) are not coterminous with
one local authority,[111]
and pushed for the devolution of budgets to MAAs where they had
an agreed policy, for example for sub-regional transport or adult
skills projects.
83. We welcome the commitment the Secretary of
State gave to us that:
[
] where local authorities and their partners
are prepared to put their differences to one side and say, "these
are our priorities around planning, housing, transport and skills",
key economic drivers, again they will get more devolution from
the centre, not just from CLG but from DIUS and DCSF [
][112]
We agree that MAAs offer some scope
for local government leadership at the sub-regional level. We
welcome the fact that, following the conclusion of its Sub-National
Review (SNR) consultation exercise, the government is currently
legislating to put MAAs on a statutory footing, and that groups
of council leaders will have joint responsibility with Regional
Development Agencies (RDAs) for drafting and implementing regional
strategies. We also welcome the Chancellor's recent announcement
in his Budget speech that Manchester and Leeds will become city
region pilots with enhanced powers.
84. Finally in this section, we also welcome
the move to replace the Comprehensive Performance Assessment (CPA)
with the lighter touch Comprehensive Area Assessment (CAA) under
the general oversight of the Audit Commission. It seems sensible
to us to place more emphasis on assessing the success of partnership
working in delivering the place-shaping role, rather than focusing
on a large list of individual indicators.
Although
we accept that there will always be a need for an external review
of standards, the challenge will be to ensure that hard targets
are not simply replaced by a range of softer audits, reviews and
report backs that, in total, serve the same invasive purpose and
continue to tie down local government resources and stifle innovation.
We were pleased to hear the Secretary of State
confirm that:
I am very conscious and aware, and I am monitoring
this very closely, that when we reduce targets sometimes there
is a temptation for people to institute softer controls, whether
that is reporting, accounting frameworks, whatever. I am keeping
an intensely close eye on all of that because what I do not want
is for our genuinely devolutionary, lighter touch framework to
be thwarted by people wanting to come in at the edges with other
forms of control.[113]
We are pleased that CLG is "keeping a really
close handle on all of this on behalf of the whole of Whitehall".[114]
We look forward to monitoring the success of CLG and the Audit
Commission in delivering an effective but genuinely less obtrusive
performance framework. Regulation and audit are overhead costs
for local government and need to be proportionate to the benefits
achieved.
The case for local government
cultural change
85. It is our assessment that, however slowly
and imperfectly, the balance of power is tilting back towards
local government. We believe that a further push is required
in order fully to realise the benefits of these positive developments,
and to enable local people, through their local councils, to have
a greater say in the development of their locality. However, a
number of witnesses highlighted to us their concern that local
government itself was not prepared to take full advantage of the
opportunities.
86. A number of witnesses suggested to us that
there is a lack of ambition in local government. Anna Turley,
for example, told us that the fact that some 80% of local government
budgets come from central government "has created a bit of
a culture of pleading and wanting".[115]
Andy Sawford, Chief Executive of the LGiU, similarly observed
that "local government I think would accept, and we certainly
would acknowledge, that it has not been as ambitious as we would
like it to be", adding "I do not think they can hide
in a corner any more and say, 'we are all being done to. Central
government is constraining us and we cannot meet the public's
expectations' [
]",[116]
whilst Sir Michael Lyons told us that, whilst central government
needed to change, local government too needed "to put its
own house in order".[117]
Professors George Jones and John Stewart in their written evidence
and Nick Raynsford MP during his oral evidence session all highlighted
a culture of "deference" in local government. The Local
Government Association (LGA) itself has not been exempt from criticism
on this point. Professor John Stewart, for instance, felt that
the LGA had "gone too far in accepting the views of central
government", and had let itself be "browbeaten"[118]
into signing the concordat. Baroness Hamwee told us similarly
that the LGA is "too supportive of what is going on and [is]
not sufficiently critical either of central government or frankly
themselves."[119]
87. We have encountered examples
of local government already undertaking a very proactive local
leadership role. We were, however, disappointed to note that local
government has become so used to existing in a culture of central
control that the ambition to take on powers and responsibilities
from central government is sometimes limited and even timid. Where
local government has been cautious, it is perhaps understandable
given past history and the untested nature of some of the new
frameworks. What local government, including the LGA, needs to
do now, in line with its local leadership role, is to keep testing
the boundaries. The more local government can demonstrate that
it has the drive, determination and vision to improve the lives
of its communities, the harder it will be for outside commentators
to sustain the argument that the culture in which local government
operates has become overly deferential towards central government.
88. Both in their oral evidence and in a recent
publication[120] the
LGA made a persuasive case for cultural change also at the national
level. Given the extent to which power currently rests with central
government, it is on central government that the onus rests to
promote cultural change at every tier of government, and hence
sow the seeds for a growth in local government ambition. Accordingly,
in the next chapter we will consider in more detail the role of
central government in the English system.
45 These examples are taken from Roger Gough, With
a Little Help from our Friends: International Lessons for English
Local Government, (London 2009). Back
46
The Lyons Inquiry, Final Report, (London 2007) Executive
Summary, paragraph 25. Back
47
Q 266 Back
48
Ev 158 Back
49
We consider the case for minimum standards in the next chapter Back
50
Ev 124 Back
51
Ev 164 Back
52
Ev 162 Back
53
Ev 164 Back
54
Ev 165 Back
55
Ev 165 Back
56
Ev 158 Back
57
Ev 148 & Ev 237. Back
58
Q 142 Back
59
Q 142 Back
60
Q 186 Back
61
Ev 282 Back
62
IPPR conference, Local Government Futures: the new Central
Local Relationship 15 May 2008. Back
63
Q 588 Back
64
The Lyons Inquiry, Final Report, (London 2007) Chapter
7, para 251. Back
65
Q 164 Back
66
Ev 159 Back
67
Positively charged: Maximising the benefits of local public
service charges (Portsmouth 2008). Back
68
Ev 184 Back
69
Ev 141 Back
70
Q 228 Back
71
Q 228 Back
72
Q 518 Back
73
Q 518 Back
74
Qq 643-644 Back
75
Ev 286 Back
76
Q 151 Back
77
Q 241 Back
78
Q 241 Back
79
Ev 171 Back
80
Q 269 Back
81
Q 270 Back
82
Q 271 Back
83
Q 271 Back
84
Ev 182 Back
85
Q 271 Back
86
Q 274 Back
87
Ev 171 Back
88
Local Government Association, Policing Green Paper - LGA Response,
dated 10 October 2008. Back
89
Q 274 Back
90
Ev 138 Back
91
Q 293 Back
92
Q 293 Back
93
Q 313 Back
94
Q 307 Back
95
Q 317 Back
96
Q 327 Back
97
Q 333 Back
98
Q 335 Back
99
Q 376 Back
100
Q 376 Back
101
Q 145 Back
102
Q 148 Back
103
Q 341 Back
104
Ev 160 Back
105
Q 77 Back
106
Q 83 Back
107
Q 85 Back
108
New Local Government Network, Deal or No Deal-delivering LAA
Success, 13 October 2008. Back
109
Ev 157 Back
110
Ev 201 Back
111
Ev 266 Back
112
Q 583 Back
113
Q 585 Back
114
Q 585 Back
115
Q 281 Back
116
Q 282 Back
117
Q 12 Back
118
Q 421 Back
119
Q 481 Back
120
Local Government Association, One country, two systems how
national and local democracy can work together to improve Britain's
political culture, 2008. Back