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Archive for the ‘Local government’ Category

Thursday
Mar 8,2012

The Government successfully fended off an attempt to ensure that HealthWatch England (the national body that is being set up to represent the interests of patients) is a genuinely independent body in the House of Lords this afternoon.

Under the proposals in the Health and Social Care Bill HealthWatch England is constituted as a committee of the much-criticised NHS regulator, the Care Quality Commission.  The amendment, which I had seconded would have made it a genuinely independent body and given it responsibility for supporting and funding local HealthWatch organisations.

In the end the amendment was narrowly defeated by  165 votes to 189 – a Government majority of 24 (44 Liberal Democrats voted against the amendment, none voted for it).

For those with time to kill, my speech was as follows:

“My Lords, I think this is the part of the Bill which I assume the Minister had hoped would give him a quiet time. Indeed, he has passed on the responsibility for answering this amendment to his noble friend Lady Northover. Originally, one had to respect the Government’s intention with regard to HealthWatch because I am sure the intention was to create effective patient representation at national and local level. That intention has been challenged in the discussions that we have subsequently had and in some of the changes that have occurred over the past few months. However, it is worth going back for a moment to first principles. What constitutes effective patient representation? The first significant element of that has to be independence. The organisation representing patients’ interests has to be independent of the providers of health services, those who commission them and those who regulate them because the act of representation can potentially challenge any or all three of those interests.

Secondly, effective representation at national level must be representative. There must be real representativeness within that structure. It must be derived from local groups and local individuals and have that authority which is derived from being a representative structure. With the best will in the world, you cannot be an organisation which can speak with proper authority on behalf of patients or, indeed, any consumers if you are simply appointed from on high by a Secretary of State. In my time, I have worked for organisations that have been structured like that and I have to say that although they can do good work, they cannot be properly representative. They cannot properly have the authority that comes from being derived from the grass roots. The third element which is critical is that the work and the comments that these bodies produce have to be derived from sound local information, which necessitates being able to pick up information from local networks around the country. That has to be safeguarded in whatever proposals are put forward.

The Government originally promised us that HealthWatch England would be the independent patients’ champion. However, as the noble Lord, Lord Patel, has just pointed out, being a subcommittee of the Care Quality Commission does not demonstrate independence. It demonstrates a subsidiary role in relation to the Care Quality Commission. I am sure that the people currently at the Care Quality Commission are motivated to try to create an arm’s-length structure. We do not know, of course, whether that desire for independence would survive the first occasion when HealthWatch England challenged the decisions made by the Care Quality Commission, or how often it would survive after repeated such challenges. However, independence is also about the perception and the appearance of being independent. How can you appear to be independent if you are a subcommittee of one of the organisations that you may have to criticise from time to time?

This amendment seeks to do three key things. It would set up HealthWatch England as an independent statutory body and write that independence into statute, set out a clear relationship with local healthwatch organisations and safeguard their funding mechanism. I recall some very wise words said to your Lordships’ House in July 2007 when we were debating the creation of the Commission for Patient and Public Involvement in Health. It was stated that,

“one signal advantage of the commission is that the money that it distributes to forum support organisations cannot be used for purposes other than those for which forums were established. Under the arrangements in the Bill, however, there is no guarantee at all that money intended to support the activities listed … will actually reach the front line. It would be possible for a local authority to say that it was delivering the activities in the Bill when, in reality, those activities were so minimal that they were hardly worth the name of patient and public involvement. What steps could be taken, in those circumstances, to ensure that such involvement in health and social care is delivered properly?”.—[Official Report, 23/7/07; col. 615.]

The person speaking said that the answer was not delivered by the Bill brought forward at that time by the Labour Government. Who was the person who delivered those words? It was, of course, the noble Earl, Lord Howe—the current Minister. He made it quite clear that the arrangements which he is now seeking to replicate were not adequate and would not, and could not, work. Yet the proposals which were going to establish the independent patients’ champion are weakened precisely because he has not accepted the lessons of his own words.

The noble Earl, Lord Howe, went on to say that he was concerned that, as:

“LINks are going to assume different forms and guises in different localities, it is axiomatic that the level of activity that they undertake is going to vary”.—[Official Report, 23/7/07; col. 615.]

He asked how the amount of money in any given area was to be assessed. Therefore, I ask the noble Baroness—who will respond on behalf of the noble Earl, who gave us that wise advice in 2007—what will be the mechanism for determining how much money is allocated to each local authority for healthwatch in its area? Will this be a global sum that will go from the Department of Health to the Department for Communities and Local Government, and then be allocated to local authorities by the mysterious process by which the block grant from the DCLG is decided for each local authority area? Or will there be a separate formula that will go with that money and decide how much money is allocated to local healthwatch around the country? If it is the latter, will that information be published? Will it be possible for residents in a local area to know how much money has been allocated so that they can see whether it is being used? I suspect that unless we have the answers to those questions we will know that the reality is that this money will disappear in the wash and not be effective. The point about the amendment is that it provides a solution to that problem because the same money would be channelled through a body that would be dedicated to the provision of local healthwatch organisations and want to ensure that the money was spent properly and appropriately.

The Government’s arguments—we have had several discussions about this with Ministers, and I am grateful to the noble Earl and the noble Baroness for providing those opportunities—seem to be broken down into three areas. First, they argue that there is a natural synergy with the work of the Care Quality Commission. However, I have already pointed out that the CQC is one of those bodies that HealthWatch England may have to criticise. There is also a synergy with the work of the NHS Commissioning Board, Monitor, Public Health England and all sorts of other parts of the new NHS. Why is there specifically a synergy with the CQC?

The Government’s second argument was that there would be cost efficiencies and that this would be the most efficient way of doing this because there would be savings due to the collocation. However, as the noble Lord, Lord Patel, pointed out, you can achieve that in many ways. You can simply say that one of the things that HealthWatch England, as an independent statutory body, could be required to do through guidance, would be to look at how its back-office operations could be provided from a variety of organisations of appropriate stature and size, where the issue of conflict would not necessarily arise. That provision could then be made by way of a clear legal agreement. However, that is not being done, and I am not quite sure why the Government are saying that there are efficiencies and cost savings that could be made only by the precise structure that they propose. In terms of providing the funding to local healthwatch, our proposal has to be a more efficient provision that will deliver the resources without leakage and without local authorities deciding that perhaps there is a greater local priority than local healthwatch.

The noble Baroness, Lady Northover, spoke vehemently about the way in which the former Commission for Public and Patient Involvement in Health had operated, and how it had a wasteful and top-heavy way of distributing resources to local patients and for public involvement. That is not the only way to distribute resources. The only reason that the former commission distributed resources in that wasteful and inefficient way is because the Department of Health at that time—I regret, led by a Labour Minister—insisted that it was done in that rather ridiculous and cumbersome way. If Ministers want distribution done efficiently and simply, perhaps that can happen. If you appoint the right people to the initial board of HealthWatch England, I am sure that they would want to ensure that that is the case. It does not have to be done in the way I described.

The third argument that I have heard Ministers make for locating this body within the CQC is that it will provide all sorts of informal support and guidance—that there will be a library, information resources and so on. However, the Government have told us how important the duty of collaboration is within the new NHS and how significant it will be. Why do you need to collocate and have HealthWatch England as a subordinate structure within the CQC when there is a duty to collaborate? Indeed, why cannot HealthWatch England collaborate with other national bodies as part of the NHS?

Within this group there are other amendments, including Amendment 224 and 225, which propose that the majority of members of HealthWatch England will not be from the CQC and will be appointed by local healthwatch. I have two concerns about those amendments. Why cannot all the members be derived from local healthwatch organisations? The bigger question comes in a later group of amendments, which is: if you have destroyed the statutory status of local healthwatch organisations, how can contractors, which will be delivering local healthwatch services at a local level, deliver representatives to a national structure? Will we thereby have representatives of different local social enterprises appointing people to sit on a national body? That is a strange representative structure.

Then there is Amendment 226ZG, which is the Government’s answer as to how they make sure that local healthwatch organisations are satisfactory. This gives HealthWatch England—this sub-committee of the Care Quality Commission—the power to write a letter. It is the power to write a letter to a local authority and say, “In our opinion, the local healthwatch organisations that you have organised in your area are insufficient”. My goodness, as a former local authority leader, I know that I would be quaking to receive a letter from a sub-committee of a national organisation that did not really regulate anything that I was particularly bothered about, telling me that I was not doing something absolutely right. There would be no enforcement powers and no means of intervention, but the power to write a letter. Brilliant. Excellent. It is just what we are looking for. It offers hardly any solution, although I appreciate the concession that the noble Baroness and the noble Earl have made in that amendment.

I conclude by saying that this is not a party-political issue. The previous Government got this wrong and, sadly, the present Government look as if they are about to get it wrong. This was an opportunity to get it right. Patients need effective representation, particularly in the context of the Bill. Even if you believe that the Bill will deliver to us a better health service—and I am obviously not one of those—patients need to be given confidence that their interests will be properly represented. At the moment, the arrangements proposed by the Government do not do that. That is why an independent HealthWatch England is so important.”

 

Tuesday
Mar 6,2012

Dave Hill’s London Blog in The Guardian can usually be relied on for serious comment and analysis of London issues. And last week he posted two important posts on the issue of serious gang-related violence in London.

The first highlighted the post-code rivalries between gangs in North-West London:

“Page 81 of my London A-Z shows the streets, parks and stations at the intersections of north Westminster, north Kensington and Brent. But it offers no clues to the alternative cartography that shapes the lives of many people living there – an unofficial map of an urban landscape scarred by violence and divided by fear. …

Territories have been defined and the borders between them guarded and sometimes breached. Incursions resulting in chasings, beatings and robberies are frequent. …

Some who live in the area concerned, including some who are young, are barely touched by this wired, short-fused youthful world. They and it are largely invisible to each other: people move freely and routinely to and from work, local schools, community facilities and places of worship just like anywhere else. Yet an awareness of that other side of neighbourhood life has filtered down even to primary school children. And on the streets young people in particular, even if they have little or no direct connection with it, are acutely conscious of it: at worst, cowed, menaced and controlled. …

 In this increasingly less subterranean world the streets are an excitingly dangerous playground – a place that’s more available, more plausible and more rewarding than the alternatives of education, conformity and long-term, steadier rewards. Yet though that playground may be larger than those at primary school, it is both limited and limiting too. The horizons of those playing crazy, deadly games there don’t extend geographically, intellectually or emotionally even as far as A-Z pages 80 or 82.”
The second cited a report from the Centre for Crime and Justice Studies at Kings College, “Young People, Knives and Guns”, which concluded that:
“focusing on weapons themselves can be a distraction from addressing the underlying causes of violence and that the most effective interventions engaged instead with “the big questions of disadvantage and social exclusion” along with addressing individual, family and neighbourhood problems. It also found that in the United States locally-based strategies where a variety of agencies work closely together to combine different prevention and suppression approaches have been more effective than “enforcement-led interventions by agencies operating in isolation.””
Later in the same post, Hill describes the experience of youth and community workers he had met:
“There was a strong consensus that every neighbourhood affected and individual involved is different, and that responses should be tailored accordingly. A unified view was also expressed that police officers with listening ears who know a neighbourhood well are an asset, but that vanloads of territorial support group members sent in from elsewhere to conduct stop-and-search blitzes can cause more problems than they solve. Far better that police energy was put into co-ordinating activities across borough lines and building trust with the communities they serve.

There was a general frustration that funding for anti-youth crime and violence projects is too often short-term and under threat, making the sustained action required far more difficult to implement. Outreach work, personal development and gang mediation schemes were all thought to have beneficial effects, so why couldn’t they be backed with more consistency and on a larger scale?”

Certainly my perception for what it is worth is that gang-related violence seems to have got significantly worse in London in the last couple of years or so.  This is not intended to be a political point because I am not sure that there is a simplistic cause and effect between political decisions or for that matter policing decisions and changes in the levels of violence or gang-related activity.
I am also told that at least one magistrates court in London checks through the lists of cases coming up so as to ensure that cases involving rival gangs are scheduled on different days to stop fights breaking out on court premises.
However, what is clear is that a number of things that are happening will clearly be making the situation worse – what the Centre for Crime and Justice Studies call “the big questions of disadvantage and social exclusion”.
Thus, a worsening economic situation with fewer opportunities for young people will create an increasing sense of hopelessness and futility fostering a breeding ground for both extremism and for gangs.  In this context, scrapping the Educational Maintenance Allowance seems a particular folly and which is why Ken Livingstone’s pledge to restore it in London makes sense.
Similarly, cutting local authority budgets will both increase local joblessness but is also likely to mean that specialist youth and community provision will be lost – again hardly helpful in this context.
Tackling the environment in which gangs flourish is the key.  Too often in too many parts of London for too many young people being part of a gang is the only way of having any security – both physical and emotional.  These are not easy issues to tackle, but it is obvious that some policies will make things worse.
Saturday
Mar 3,2012

On Friday, when Parliament was not sitting, the Government published 68 amendments to the Health and Social Care Bill changing the status of local HealthWatch organisations (the local bodies that are intended to protect patient interests in the new Tory/LibDem vision of the Health Service), as I predicted a few weeks ago.

The amendments are very complex and difficult to follow – they amend amendments to Part 14 of the Local Government and Public Involvement in Health Act 2007.  And they are scheduled to be debated next week during the House of Lords Report Stage consideration of the NHS Bill.

That means that these amendments – slipped out without proper warning or explanation (a normal courtesy of writing to those Peers with an interest in a particular matter doesn’t yet seem to have happened in this case) – will not receive proper Parliamentary scrutiny.  They have never been considered by the House of Commons (and, if passed in the Lords, will now only be taken there as part of the truncated Consideration of Lords Amendments procedures).  In the House of Lords, they have not been subjected to detailed scrutiny at Committee Stage and will essentially have to be debated on a take it or leave it basis when they are eventually reached probably some time late on Thursday.  That will be the only opportunity for any  discussion on what these amendments mean.

So what are these amendments about?

The biggest change is to remove Clause 181 and Schedule 15 of the Bill.  These established local HealthWatch organisations as statutory bodies with a defined local membership (appointed in accordance with regulations) that could employ staff, would meet in public etc.

Instead, local authorities will be expected to make “arrangements” with a body that “a person might reasonably consider … acts for the benefit of the community in England”. And these bodies will then be able to sub-contract the patient representation work further.

The role of the national body, HealthWatch England (which the Government still want to be a sub-committee of the heavily-criticised Care Quality Commission) to advise local HealthWatch organisations is also being diluted with their power to give “advice” being changed in another amendment to a weaker role of giving “general advice”.

Presumably as a sop to people like me who had complained that there was nothing to require local authorities to provide an adequate local HealthWatch organisation (or even to spend the money allocated for local HealthWatch for that purpose), there is an amendment that gives HealthWatch England the power to give a local authority “written notice of its opinion” that the services expected of a local HealthWatch organisation are not being provided properly.  This gives HealthWatch England the power to write a letter, but that is all.  There is not even a requirement for a recalcitrant local authority even to respond to the letter.  I am sure they will be quaking at the prospect!

The Government acknowledges that there may also be a conflict of interest between a local HealthWatch organisation and the local authority that is responsible for setting it up and funding it (for example, if a local HealthWatch criticises the quality of the social care provision provided by a local authority).  They are therefore putting forward an amendment saying that local authorities “must have regard to any  … guidance on managing conflicts” that the Secretary of State may issue.  Again, not much of a safeguard.

The amendments also seem to envisage that a local authority may get different contractors to provide the various functions of local HealthWatch organisations, so one contractor may “gather information” and “make recommendations”, another may be responsible for “monitoring” services with the power to “enter and view” them, a third might provide advocacy services and a fourth might be responsible for “influencing commissioning”.  This is hardly a recipe for an effective structure.

And there is another strange amendment which suggests the possibility of imposing a requirement that  in any area “Local HealthWatch contractors (taken together) are representative of people who live in the local authority’s area”.  This acknowledges that there are likely to be several sub-contractors providing patient representation services in an area, but also opens up the possibility that the sub-contractor providing one service may not be representative provided the other subcontractors compensate for the first’s unrepresentativeness.

Without these amendments, there would at least have been some clarity as to what a local HealthWatch organisation might look like – even though they would be hampered, possibly shackled and potentially starved of funds by being subservient to the local council in their area whose social care provision they would be monitoring.  However, with these amendments local HealthWatch organisations are likely to be fragmented and will lose the authority they would have had by being statutory bodies.  What is more by deleting the schedule that would have specified membership arrangements and governance they will now be shadowy and unaccountable structures.

The net effect of these amendments will be to make it more likely than not that the new local HealthWatch organisations will be ineffective and that there will be no proper and coherent structure of patient representation at local level.

One can only speculate as to why these amendments have been brought forward in this way at this time.

One possibility is that some obscure unit in the Cabinet Office charged with dismantling the public sector suddenly realised that there was a bit of the Health and Social Care Bill that did not facilitate privatisation and instructed the Department of Health to change it.

Another is that Department of Health Ministers have realised that the changes they are making to the NHS are so unpopular and are likely to have such a damaging effect on patients that they simply cannot risk having an effective mechanism for patients’ interests to be represented.

I don’t know which is the real reason, but it is difficult to conceive of any other rational explanation.

Thursday
Feb 9,2012

After the excitement of the Government’s defeat in the House of Lords yesterday afternoon by a margin of four votes (with the Convenor of the Liberal Democrat Peers, Lord Alderdice,voting against an amendment he had both signed and spoken in favour of) on the principle of mental health issues being given greater priority within the NHS, the rest of the days proceedings might have been a bit of a damp squib.

However,the later debates illuminated what a dog’s breakfast the whole Health and Social Care Bill has now become.

For example, at one point I tried to elucidate what would be the mechanisms to drive up quality in local healthcare provision and how would health inequalities between commissioning group areas be addressed, saying:

“My Lords, I support the amendments in this group because I believe that it is important that we look at the mechanisms that will be embedded in the Bill, assuming that it eventually receives Royal Assent in some form, and that will in practice drive change in the direction that we all want. That includes improving the quality of the care offered, and it means addressing the issues of health inequality to which the noble Baroness, Lady Tyler, referred.

One of the omissions from the Bill is that, apart from placing some general duties on the various bits of the NHS, there is very little about demonstrating how those duties will then be exercised or creating a mechanism for assessing that. The amendment, which talks about reporting annually to Parliament on the progress made, seems an essential first step in making sure that that happens.

The reports on inequalities will be increasingly important in this area. However, Amendment 112, dealing with CCGs’ annual reports on how they have discharged their duty to reduce inequalities, raises another question, and this comes back to the issue of what will be the catchment areas of individual CCGs. Unless there is far more central direction than I have understood—and perhaps the Minister can reassure us on that—it seems likely that there will be, to use an unpleasant term, ghettoisation in some CCGs.

In some local authority areas, the easier bits of the patch will have one CCG and another will cover the others. That is likely to mean that the areas covered by those two different CCGs are rather more homogeneous than might otherwise be the case. If one CCG covered that area, the duty to make progress on health inequality would be clearer. If we are talking about smaller populations served, it is more likely that they will be homogeneous and that there will therefore be less inequality to address. The question will be whether there will be enough pressure within the system to ensure that the inequalities in health outcome between different CCG areas will be addressed. It is all very well to place a duty on a CCG which covers, say, the people of Tottenham in north London, where there are tremendous problems of health status, life expectancy and so on, to report on what it is doing to eliminate health inequality in its patch, but if the nature of that patch is such that it is already deprived in terms of both economic indicators and health outcomes, what will be the driver to ensure that the inequality of that area compared with others is addressed?

Who will own the strategy within regions and parts of the country to address issues such as health inequality and clinical standards? If the answer is that that this will all be done by the NHS Commissioning Board, that is a wonderful answer and tells us what an important body the NHS Commissioning Board will be. How will that be operationalised? What mechanism will drive that? Before you know it, you are talking about a regional and area infrastructure no less baroque than anything we have seen in the past. Otherwise, it cannot happen. What will be done to operationalise the drivers to make the improvements happen? It will not be sufficient to place a duty on everyone to report on what they have done, although that is valuable and worth while in itself. What will be the duty to address issues between localities? You can address all the inequality you want within those areas, but if the outcomes are already much lower in those areas, will there be enough infrastructure around the NHS Commissioning Board to address the problem of the inequalities between the different areas?”

In reply, the Minister, Earl Howe said:

“The noble Lord, Lord Harris, asked me about clinical commissioning groups and referred to their geographic coverage. He will know that each CCG will be accountable for the outcomes that it achieves against the commissioning outcomes framework, which is under development. The CCGs will be supported in their efforts to improve quality by the NHS Commissioning Board, whose job it will be to issue commissioning guidance, informed, among other things, by NICE quality standards.

I do not agree with the noble Lord that CCGs are likely to be ghettoes. Across many clinical areas, they will collaborate to serve the needs of patients over an area wider than that of just a single CCG. What is not stated in the Bill but I hope is implicit in all that the Government have said is that there will be transparency in all this. Once you measure results, there is, ipso facto, an incentive to improve those results.

The noble Lord, Lord Hunt of Kings Heath, asked me how a CCG can influence improvement in primary care when it is the board that is commissioning the primary care. I simply remind him that CCGs have a duty under the Bill to support the NHS Commissioning Board in its quality improvement functions with respect to primary care. Indeed, one of the key benefits of CCGs as we see it—and we know this from a practice-based commissioning which has been in place for a number of years—is the ability for peer review and peer pressure to drive up quality.

The noble Lords, Lord Harris and Lord Hunt, asked me who will lead the local strategies. Health and well-being boards will be the bodies that will produce a joint health and well-being strategy, and that will be designed precisely to address issues such as health inequalities, which involve different services working together. CCGs must have regard to these strategies in addition to reporting annually on health inequalities, as through the amendments in this group.”

Shortly afterwards, I intervened to try and clarify the point and this was the exchange:

“Lord Harris of Haringey: I just want to make sure that I understand the point that the Minister is making. Let us compare two localities in London. I mentioned Tottenham, so compare that with, say, the residents of Totteridge. They are very different socioeconomic groupings with very different health outcomes. What is the mechanism for addressing health inequalities between Tottenham and Totteridge? Who will be responsible for addressing inequalities between areas that are just a few miles apart but which have very different characteristics and very different social outcomes? The health and well-being boards are borough-based. Tottenham is in the London Borough of Haringey and Totteridge is in the London Borough of Barnet—neighbouring boroughs that are very different in composition. What will be the overarching structure that addresses those inequalities?

Earl Howe: Localism lies at the heart of our approach to these issues. Although I have no doubt that conversations and comparative analyses will take place between different health and well-being boards and different local authorities, in the end it is the responsibility of health and well-being boards to look to their catchments. As I said, the outcomes that are published, both in terms of the NHS performance and public health and social care, will in themselves incentivise improvement, if the local authority and the health and well-being board work together as they should. This is a joint enterprise between public health, social care and the NHS.

We shall no doubt experience the effect of comparative work between local authorities once the early implementer groups have bedded down and begun their work. Both the board, however, and the Secretary of State will have duties in relation to inequalities. They overarch everything that happens and I suggest that that will ensure that a system-wide and strategic approach is taken, for example, through setting objectives in the board’s mandate in relation to inequalities. These could feed down very easily to CCGs through commissioning guidance issued by the board. I hope that that gives the noble Lord a summary, or at least a flavour, of how we envisage this working.

Lord Harris of Haringey: May I just clarify? Will there be nothing between the board at national level? Will it look right across the country and say, “We will address these inequalities”? Will there be nothing, for example, at the London level, to address inequalities between different parts of London or will it simply be driven nationally? That is a recipe for not necessarily making the best decisions in particular areas.

Earl Howe: The noble Lord will know, because the NHS Commissioning Board authority has published its proposals, that the board will be represented sectorally. There will be field forces in all parts of the country. My vision of this, and that of Sir David Nicholson is that in the areas in which the board operates it will take a view across a region and look at how outcomes vary between local authority areas. The board will be very powerfully placed to influence the kinds of inequalities that the noble Lord has spoken of. It is important for noble Lords to understand that the board will not be a collection of people sitting in Leeds. The majority of its staff will be a field force. I hope that that is helpful.”

So the NHS Commissioning Board will have an army of staff, active in every region and locality “influencing” local Commissioning Groups.  (This army will, of course, be anonymous and unaccountable – except at national level through the NHS Commissioning Board and the Secretary of State will try to imply that none of what happens is anything to do with him.)
A later exchange on another amendment amplified the point:
Baroness Jolly: Before the Minister sits down, will he clarify whether the same processes that he has just outlined would apply to people in receipt of specialist services that are commissioned by the NHS Commissioning Board, not by local CCGs?

 

Earl Howe: My Lords, where a service is commissioned by the NHS Commissioning Board—and let us imagine that it is a specialised service—the patient’s recourse should be to the board. However, of course, the board will be represented at a local level rather than only centrally, and we expect that the board will be represented in health and well-being boards and in the discussions that take place there. It would therefore be possible for a patient to address their concerns, in the first instance, to the health and well-being board, which would have the ability and power to communicate directly with the NHS Commissioning Board, if that was felt to be appropriate. However, as I said, the patient would be able to go straight to the board in those circumstances.

Lord Harris of Haringey: I appreciate that this is very bad manners, given that I missed most of the debate. The Minister has just said—although perhaps I misinterpreted him—that the NHS Commissioning Board will have a representative on every local health and well-being board. If so, how will those individuals be known or accountable? Is that not the most extraordinary bureaucracy? He seems to have made a most extraordinary statement.

Earl Howe: My Lords, we are at Report stage and I hope that the noble Lord will forgive me if I do not reply at length. The point I was seeking to make was not about representation on the board but involvement in the health and well-being board’s wider deliberations. It is entirely open to a health and well-being board to invite a member of the Commissioning Board to be a permanent member, but I am not saying that we are prescribing that.’

So there will be – or at least can be – NHS Commissioning Board staff “influencing” or even sitting on local Health and Wellbeing Boards.

By now I was becoming even more curious about the extraordinary reach of the NHS Commissioning Board and in a debate on the proposed duty to encourage “autonomy” for local NHS bodies I pursued the topic again:
“My Lords, every time I look at Clause 4—[Laughter.] I cannot understand what my noble friends find so amusing, but every time I look at this particular clause—if that makes it easier for them—and particularly listening to the remarks of the noble Lord, Lord Marks of Henley-on-Thames, I have been confused as to what problem the Government think they are solving by the clauses on autonomy.There is apparently a concern about micromanagement. There is a desire to have local innovation, flexibility and local responsiveness. What is it about the current arrangements in the NHS that necessarily prevents local innovation, flexibility and local responsiveness? Why are we having these discussions? If there is a concern from the Government that they are micromanaging, they have a solution—they stop micromanaging. Again, what are we trying to do here?However, once you include,

“the desirability of securing, so far as consistent with the interests of the health service”—

or whatever form of words you choose to have—this principle of autonomy, you are setting up an automatic conflict. If the form of words that the Minister and the noble Lord, Lord Marks of Henley-on-Thames, have put their names to was in the Bill, does this mean that the Secretary of State will be intervening when there are clear cases of postcode lottery? That presumably is the implication. Or is the Secretary of State now going to say that in fact a postcode lottery is what this legislation is designed to create? We should be clear what these clauses are trying to prevent. What is the problem that they are trying to solve?

The noble Lord, Lord Marks of Henley-on-Thames, was moving in his description of how the Secretary of State would weigh these difficult issues of the possible conflict between,

“the desirability of securing, so far as consistent with the interests of the health service”,

autonomy and the priorities of the fundamental role of the NHS. This is a balance that has to be weighed. He talked about this line of accountability that will exist between the NHS Commissioning Board and the CCGs—these tentacles that the NHS Commissioning Board will put throughout the NHS. They will be unaccountable and anonymous, and individuals will be operating at regional or at local level.

There will be an army of people operating as the tentacles of the NHS Commissioning Board. They will be informing the Secretary of State so that he can exercise his judgments about the balance between autonomy and meeting the principles of the NHS. I wonder whether the Secretary of State is creating the most extraordinary bureaucratic monster to solve a problem that could be easily solved simply by resisting his tendency to micromanage.”

And this prompted further exchanges:

Earl Howe: My Lords, the noble Baroness, Lady Thornton, has spoken to Amendments 10 and 52, which, as she has said, would remove altogether the autonomy duties on the Secretary of State and the board. The noble Lord, Lord Harris, asked me what the problem is that the Bill is trying to solve in this regard. The duty is intended to promote a culture of fostering local autonomy rather than to outlaw specific practices; but without a focus on autonomy, it is possible that the mandate from the Secretary of State to the board or the framework document from the board to CCGs could impose disproportionately burdensome requirements on the system. The Government believe that local operational autonomy is essential to enable the health service to improve the outcomes of care for patients, provided that autonomy is within the framework of clear ministerial accountability.

The noble Baroness will be aware, because I have said it before, that we are aiming to free those closest to services to take decisions that are right for patients, free from central micromanagement by either the Department of Health or the NHS Commissioning Board. The amended duties, with the caveat that the interests of the health service take priority, achieve the right balance between autonomy and accountability. Without the clause, a future Secretary of State could choose to ignore one of the fundamental principles of the Bill, which is that those closest to patients are best placed to take clinical decisions. Without the clause, a future Secretary of State would be free to use his extensive powers to micromanage the NHS. The autonomy duty is a necessary part of the Bill, placing a duty on the Secretary of State to consider the expertise of those in the health service while recognising that there will be circumstances—

Lord Harris of Haringey: My Lords, the noble Earl seems to be saying that you cannot trust your own Secretary of State not to micromanage unless they are effectively forbidden from doing so. We have all talked of the Secretary of State’s accountability to Parliament. Surely the principle is that an accountable Secretary of State will be under enormous pressure from Parliament not to micromanage. If it is such a central issue of policy, Secretaries of State should simply be told not to do it, rather than requiring an Act of Parliament.

Earl Howe: I challenge the noble Lord to think of one Secretary of State, with the distinguished exception of my right honourable friend Mr Lansley, who has not succumbed to the temptation of micromanaging the NHS. No Secretary of State has been able to resist that temptation because, frankly, Parliament expects them to do it. That is what the system has expected of the Secretary of State. This is a burden on commissioners and clinicians, and, in the end, it does not well serve the interests of patients. It is all very well for the noble Lord to say, “Well, just stop”, but the system encourages it and the duties on the Secretary of State are there to encourage it.

Baroness Thornton: I cannot resist saying that the noble Earl’s right honourable friend Mr Lansley has dabbled and intervened on at least 12 occasions since the Bill started. He is on the record as saying on one of those occasions that certain managers should be sacked. Is the noble Earl saying that that will cease when this Bill is on the statute book?

Earl Howe: I am saying that the Secretary of State will not have the ability to micromanage the health service as he does at the moment. Whether the examples cited by the noble Baroness constitute micromanagement, if my right honourable friend is just expressing a view, I rather question.

 …

Baroness Jay of Paddington: The noble Lord may be surprised to hear me ask this question because, as he kindly said, I have been very determined that the provisions on accountability and parliamentary responsibility et cetera should be strengthened in the Bill. However, I listened to what my noble friend Lord Harris said about what he described as the “increasing tentacles” of these links between the various providers and the Secretary of State. Is the Minister not becoming concerned—as I would in his position—that all this new accountability and these links undermine the basic policy positions of the Bill? That is why, for example, my noble friend Lady Thornton suggested that it would be cleaner—if that is the word—to remove the whole of Clause 4 from the Bill. The complexities that are being set up and strengthened, as the Minister has agreed, make the whole thing so incredibly complicated and bureaucratic that the underlying policy positions are being totally distorted.

Earl Howe: I do not share that view at all. I do not think that the autonomy and accountability arrangements are as complex as the noble Baroness seems to suggest. Autonomy and accountability are two sides of the same coin; one confers autonomy in exchange for accountability. That is the model that we have adopted and the one that I would hope that Parliament would wish us to adopt, given that substantial sums of public money will be at the disposal of commissioners throughout the NHS. I therefore do not see that the metaphor of tentacles employed by the noble Lord, Lord Harris, is actually very appropriate. It implies that there is an organisation holding those in the health service in a grip. That will not be the case. The role of the board is to support local commissioners; it is to be there as a resource to promote guidance, supported by the quality standards that we were debating earlier. It is not—I repeat not—a replica of the kind of line management that the NHS has seen to date.”

The reality is that the mechanism to micro-manage will be there – through the personnel (tentacles) of the NHS Commissioning Board – but presumably the micro-management will be deniable by the Secretary of State.
What a way to run a Health Service. 

 

 

 

 

Wednesday
Feb 8,2012

The Mayor of London and his policing surrogate, Deputy Mayor Kit Malthouse AM, are keen to introduce a pilot scheme in London whereby the courts could impose on offenders, whose offences were alcohol-related, a requirement that they be compulsorily tested for alcohol daily for a three months period with a positive test meaning arrest and appearance again in court.

Data in the US, where such schemes have been in place for eight years, show that reoffending rates after alcohol monitoring more than halved when compared with traditional sentences of fines or custody – with 99 per cent of tests being negative, and two-thirds of those on an alcohol monitoring scheme having perfect compliance throughout the whole period of the scheme.

This evening in the Lords, the distinguished cross-bench peer, Baroness Finlay of Llandaff, proposed a series of amendments that would permit such a pilot, saying:

“My Lords, this set of amendments concerns an alcohol monitoring requirement and is modified from those tabled in Committee on the Police Reform and Social Responsibility Bill. The alcohol monitoring requirement requires an offender to abstain from alcohol and be regularly tested to ensure compliance as part of any community or custodial sentence. It would provide an additional option—a new tool—for the courts.

These amendments would not stop responsible social drinking. They aim to deal with irresponsible, anti-social alcohol abuse and its devastating consequences. When I tabled these amendments previously, the Government’s response was that they would pilot the idea in October, using existing legislation for low-level crimes. October has come and gone. Where is the pilot? Anyway, this is needed for middle and high-level crimes, not just low-level crimes.

I should explain why we need primary legislation to undertake a proper pilot. London wants to do a pilot and will fund that pilot. The proposal has wide support. London Councils, which represents all 32 London boroughs, has written to Ken Clarke supporting the scheme. The chair of London Councils is Mayor Jules Pipe, the Labour elected mayor of Hackney. The scheme’s project board has representatives from Her Majesty’s Courts Service, London Probation, Public Health and the Crown Prosecution Service involved in developing the pilot. Consultation has involved domestic violence victims, Refuge, Women’s Aid, domestic violence offenders, health leads and those with an interest in the night-time economy from transport to addiction support services.

Today, I spoke to Bernard Hogan-Howe, the Metropolitan Police Commissioner, who is “fully supportive” of the proposal. He commented that alcohol is a precursor to crime in about 80 per cent of crimes in London and that after six o’clock at night you can smell the problem in the police cells. Violence against the person offences account for 64 per cent of Metropolitan Police alcohol flagged offences and criminal damage accounts for some 11 per cent of alcohol flagged crime. We should remember that only about 10 per cent of offences get flagged as alcohol-related even though, in recent British Crime Surveys, victims believe offenders to be under the influence of alcohol in about half of all violent incidents. The commissioner wants this to be a mandatory scheme. Voluntary schemes do not work because you need to support those who most need it and who are unlikely to recognise that need without compulsion. He wants this measure to act as a driver for better health as youth binge drinking is now a common cause of end-stage alcohol-induced liver failure in those aged under 25. We have a major social and health problem.

The Metropolitan Police view this measure as an additional tool against drink-driving and domestic violence. The proposed alcohol monitoring requirement has the potential to reduce reoffending for alcohol-related crime, particularly drink-driving and domestic violence, and contribute to long-term behavioural change of offenders. …

Courts need a different sentence to tackle alcohol-related crime because what we have is just not working. Custody tears families apart and single large fines damage the children in the home more than the offender. Neither custody nor fines address behavioural change. London wants to pilot this scheme in relation to offences of violence against the person, drink-driving and domestic violence. It is recognised that developing a scheme in relation to domestic violence would require particular care to ensure that the safety of the victim, including any dependants, is an integral part of the scheme.

These amendments will enable the court to take enforcement action on alcohol-related violence and to monitor compliance, particularly regarding middle-level offences such as common assault, offences against the person, threatening behaviour and domestic violence. How would it work? Pre-court screening aims to identify alcoholics whose needs are so great that the scheme would not be suitable for them. Alcohol monitoring as part of a suspended sentence, a community sentence or post-release licence would be an alternative to custody when the magistrate is satisfied that the offender understands the demands, which are no alcohol and daily testing.

Evidence suggests that the period needs to be 12 weeks to achieve real behavioural change. The court would order the offender to pay for each test—usually £1, which is less than such offenders are paying for their drinks. Let us get this in proportion: £2 a day is less than the cost of one pint of beer in a pub or two pints from many supermarkets. The cost of the monitoring to the offender is very low compared with the amount that they are normally spending on their huge alcohol intake—even when that is irregular. Testing would be done by either a private company or voluntary third-sector agency using paid staff, not volunteers. It will not tie up police constable time.

For the pilot, test centres would use existing court and probation premises near transport hubs. The initial alcohol test would be taken with a standard breathalyser. If it is positive, a second test would be taken with evidential standard equipment and mouthpiece. Breaches, which might be through a positive breath test, non-attendance or non-payment, would be dealt with using standard processes, with a swift and modest sanction such as an extension of the monitoring period in the first instance. Non-payment will need a flexible approach, particularly for those on benefits, and will be specified in the protocol. I have gone through the draft protocol but I shall not delay the debate by going through its minutiae.

The amendments are compatible with our human rights law—in particular, Articles 5 and 8, and habeas corpus. Let me be explicit: there is no compulsion on an officer to arrest a person for non-compliance and no compulsion to detain on arrest. An officer may arrest a person only when it satisfies the test of reasonableness and proportionality in Article 5.1(b).

In London alone, almost 9,000 cases would be suitable for the scheme. Between half and a quarter of these are people who are employed. The scheme would allow them to present for testing on the way to and from work, without any risk to their job. For offenders with anger and aggression issues, counselling and family support have the greatest chance of success when the participants are sober.

Existing orders that relate to offences for low-level crimes and have been used in cases of alcohol abuse do not have a success story attached to them. The alcohol-monitoring requirement would be appropriate for medium to high-level offences that require appearance at a court for sentencing. Existing orders were discussed with the Home Office and Ministry of Justice officials, but were considered inappropriate by those who want to pilot this scheme in London because, for example, drink banning orders keep people out of an area but do not halt the abuse, and are non-enforceable. Conditional cautions need to be voluntary, involve an admission of guilt and are managed by the police. The police do not want to use conditional cautions because they do not have the manpower and do not feel that such cautions are appropriate. Anti-social behaviour orders are civil orders to tackle harassment, alarm or distress to one or more persons not in the same household, and therefore do nothing to tackle domestic violence. Community sentencing could require attendance but not testing by breathalyser. Penalty notices for disorder do not require an admission of guilt, and do not count as convictions. The current fine of £80 is suitable only for minor offences.

I am sure that the Minister will say in response that the Government plan a pilot under community sentencing, just as they did previously for low-level offences, by using tagging for secure continuous remote alcohol monitoring—SCRAM devices that detect alcohol in sweat. These devices are not yet type-approved by the Home Office. They are bulky, are fixed around the ankle, and make a buzzing sound every 30 minutes as they sample the sweat. The offender cannot travel without prior permission because they have to be near the base station to download data daily. The wearer has to connect the device to the mains to recharge and cannot bath, use household cleaning or personal hygiene products that contain any alcohol at all, because that would give a false positive reading—and the device is in place for three months. As for the collection of the £1 test cost, the principle of hypothecation locally is already in place for asset seizures. The police can already hypothecate when the money is there.

We have an epidemic of alcohol abuse in this country. We cannot carry on doing what we are doing. It just is not working. These amendments would allow a full pilot to take place in a small area. London wants to do that to discover how well it works or not, and to iron out any problems. These amendments are essential to allow that pilot to happen. I beg to move.”

The amendments were supported by speeches from all parts of the House: Liberal Democrats, Lord Avebury and Lord Carlile of Berriew; Conservatives, Baroness Jenkin of Kennington and Baroness Newlove (whose husband was kicked to death in an alcohol-fuelled murder); Labour, Baroness Dianne Hayter, Lord Willie Bach (from the front-bench) and myself; and Cross-bencher, Baroness Howe of Idlicote.

Unanimity had broken out, until the Government spokesperson, Baroness Northover (a Liberal Democrat, but no doubt a Conservative Minister would have said the same as they did when the same proposal was raised a few months ago) rose to respond.

She offered supportive phrases:

“we very much support the principle of the intention of the noble Baroness and other noble Lords who have contributed to this debate.”

Supporting “the principle of the intention” is a bit like those non-apology letters you get saying “we are sorry you found it necessary to complain”.

And promised two non-statutory pilots (which would be unlikely to reach the most serious offenders) – in due course = when the Government has published its alcohol strategy and gone throughout the approval process for the technology it wants to use.

And, of course, the Government wants

“to hear the views of the judiciary, professionals within the criminal justice system and the public on the proposals. We will therefore be consulting in parallel with the pilot schemes to ensure that we give full consideration to the purpose, effect and benefit of sobriety schemes as we develop work further.”

A long grass job.
She was not keen to apply the pilots in domestic violence cases either because as she rather strangely put it:
“We have reservations about sobriety schemes being applied to domestic violence offenders because, if you like, alcohol does not cause domestic violence although, of course, it may very well increase its severity and/or frequency.”
Apparently, it is not a priority to reduce the severity or frequency of domestic violence.
In any event, she made it clear she expected the amendments to be withdrawn and this is eventually what happened, although Baroness Finlay did warn:

“I will not press my amendment tonight, but I look forward to further discussions, and I must warn the Government that if I do not get satisfactory answers I intend to bring this back on Report.”

On a previous occasion the Mayor’s Office thought they had got agreement from the Government to go ahead.  They will not be pleased to be rebuffed again.

 

Tuesday
Jan 31,2012

The Mayor’s Office for Policing and Crime (MOPC – pronounced Mopsy by its friends) is fifteen days old.  It was launched with great fanfare – or at least a press release from City Hall – on 16th January.

There have repeatedly been assurances given that the new arrangements would be at least as transparent as those that existed with the now-abolished Metropolitan Police Authority.  Performance data and financial information would be placed on the web-site and everything we were assured would be open and visible to the people of London.

So what happens when you seek to go to www.mopc.police.uk?  You get redirected to the home page of the Greater London Authority web-site – not even its page on policing.

And where is the financial information and the performance data that was promised?

If it is there, I couldn’t find it.

Still it is early days and I am sure that Kit Malthouse AM will sort it out now that he has been formally appointed as the Deputy MOPC (a role specifically envisaged in the Police Reform and Social Responsibility Act).

But wait, is Kit Malthouse really in charge?

The press release says he has been appointed.

But, if you go to the Mayoral Decisions part of the Greater London Authority web-site, there is no Mayoral Decision appointing him.

If there is no formally recorded Mayoral Decision, any actions taken by Kit Malthouse as Deputy MOPC are invalid and ultra vires, because there has been no formal decision to give him the legal powers.

And if he has been properly appointed, the failure to post the relevant Mayoral Decision on the Greater London Authority web-site doesn’t bode well for the new era of transparency about policing that we were promised.

Or am I being pedantic?

Thursday
Jan 26,2012

The Mayor’s Office for Policing and Crime has, of course, its own acronym: MOPC (which I keep reminding everyone is pronounced Mopsy).

But the acronym has, of course, a number of other (longer-established) uses, such as the Mount Olive Pickle Company and Mouse Plasmacytoma Cells.

However, the acronym MOPC is also used widely to denote mobile body armour in the form of Condor’s Modular Operator Plate Carrier, pictured here:

Not to be confused with the standard issue anti-stab MetVest:
I just thought you’d like to know …..
Tuesday
Jan 24,2012

It is well known that there has been a major drop in crime in New York.  What is more that drop in crime was twice the rate of fall in crime across the United States and has been sustained over a twenty year period.

So what was the secret of success?  And could it be translated to the UK and to London in particular?

Professor Franklin Zimring of the School of Law at Berkeley has applied scientific analysis to the figures and has come up with a number of interesting conclusions.  The improvement was not so-called “zero tolerance” policing, focussing on stopping the spread of crime into new areas.  Instead, the results were delivered by “hot spot” policing – robust, sustained policing of those areas with the highest rate of crime (especially violent crime).

The aim should be harm-minimisation as far as things like drug use are concerned (disrupting public drug markets where associated violent crime tends to happen, for example, rather than trying to eliminate drug use itself).

Crucially, he also finds that police numbers matter – provided those numbers are directed to the areas with the highest crime and, when there, officers police “robustly”.

He is also not convinced that simply locking criminals up cuts crime.  As he puts it:

“We used to think that all we could do with high-rate offenders is lock ‘em up or they’re going to offend on the street. But NYC has 28 % fewer people locked up in 2011 than in 1990. And it has 80 % less crime. The [individual] criminals didn’t go anywhere. They’re just doing less crime. So the bedrock of prediction on which incapacitate imprisonment was built, has turned out to be demonstrably false. And the proof of that is in New York City.

The data shows that the criminal activity of people coming back to NYC from the prisons dropped as the crime decline proceeded. In 1990 the odds that a prison released from prison coming to NYC would get reconvicted of a felony over the next three years was 28 %. But over the next 17 years, the odds of being reconvicted of a felony dropped to 10 percent.

The street situation changed and so had the things that their friends were doing. People were now smoking marijuana and drinking wine. Cocaine use was down. Street robbery has gone down 84 %. Burglaries 86 %. And that meant that the people that the released offender used to hang out with as a persistent offender from a high-risk neighborhood, are no longer doing those things. So he’s not doing crimes with them.”

This obviously has implications for the current debates on prison numbers and suggests that Kenneth Clarke’s approach is potentially right, if – and it is a big if – the rest of  Zimring’s conclusions are taken on board.

So what else does his work mean for policy here?

It certainly implies that police numbers are important and that the last Labour Government (and the last Mayor in London) were right to boost the number of police.  The cuts envisaged by the present Government and those that are being carried out quietly in London by the present Mayor are therefore almost certainly unhelpful. (The lack of certainty derives from the fact that it does, of course, depend on what the police officers remaining are actually doing and whether their activity is in fact robustly tackling crime hot spots.)

It also suggests that policies favouring policing the suburbs at the expense of the areas with higher crime that tend to be in the inner cities are misconceived.

I suspect that the robust and sustained “disruptive” policing of crime hot spots is consistent with the approach that Commissioner Bernard Hogan-Howe would wish to follow.  It will be interesting to see whether this is encouraged by the Mayor’s Office for Policing and Crime (MOPC – pronounced “Mopsy”) or whether the MOPC will be nervous about the political implications in the run up to the Mayoral elections in May.

 

Sunday
Jan 22,2012

The Government’s e-petition site has rejected an e-petition calling on the Government to improve “the flow of passengers through busy London Underground stations” by installing slides in place of escalators.  The e-petition also suggests that:

“Small prizes should be available for those reaching the bottom in the fastest time. These would be paid for out of the savings of not having to maintain and operate down escalators.”

The e-petition has been rejected because this is a matter for a devolved authority – in this case the Mayor of London – and therefore it is for the Mayor of London to consider this proposal.

Thursday
Jan 12,2012

This is a piece I have written for the Mayor Watch blog on the occasion of today’s last meeting of the Metropolitan Police Authority:

“The Metropolitan Police Authority was established in July 2000 as a by-product of the legislation that also created the London Mayoralty, the GLA and the London Assembly.  Until then the Metropolitan Police had been solely accountable to the Home Secretary, who was uniquely the Police Authority for London.

The MPA is now to be abolished and replaced by the Mayor’s Office for Policing and Crime (MOPC – pronounced “MOPSY”) as a by-product of the legislation that will see Policing and Crime Commissioners elected outside London in November.

The MPA’s final meeting is taking place today and the MOPC will take over responsibility on Monday 16th January.

So what did the MPA achieve in its eleven and a half years of existence?

The early years of the MPA saw a dramatic transformation in the Metropolitan Police. In 2000 morale in the Service was poor, more officers left the Met each month than joined (police numbers had declined each year for a decade), public confidence was low, financial controls were virtually non-existent (the Met had no system for telling if bills had been paid more than once) and the quality of many serious investigations was poor.  The first tasks of the new Authority included the introduction of financial controls and discipline; establishing a new culture of openness and accountability; and reversing the decline in the number of police officers so that the MPS saw the most significant increase in its size in its history.

This was followed by a sustained focus on turning round street crime and cutting burglary.  The MPA led the way nationally on the introduction of Police Community Support Officers and then the setting up of the first Safer Neighbourhood Teams before rolling them out across London.

This contribution led to a general increase in public confidence in the police service, but specific initiatives led by the MPA on stop and search, on hate crime, and on recruitment and retention of black and minority officers also changed perceptions of the Met.

Inevitably, the direction of travel changed somewhat with a change in administration in City Hall after the 2008 elections, but the MPA continued to deliver a much clearer visible accountability of the police in London than had existed before.

Certainly, throughout its life the MPA has ensured that far more information about the policing of London has been put in the public domain.  The MPA also meant that the Commissioner and senior officers were seen to answer questions in public at full Authority meetings and at its Committees.  And this was supplemented by detailed MPA scrutinies ranging from rape investigation and victim care to counter-terrorism policing, crime data recording to mental health policing, and landmark reports on the Stockwell shooting, of the Race and Faith Inquiry, and on public order policing.

So will all this disappear with the MOPC?

The first thing to emphasise is that London’s model will – as ever – be different from that in the rest of the country.  There will not be a directly-elected Police and Crime Commissioner.  Instead, the functions will be carried out by the MOPC, led by an appointed Deputy Mayor for Policing and Crime.

The policing priorities will be set by the MOPC and it remains to be seen how much these will change from those previously set by the MPA with its more widely drawn membership.

The real danger is, of course, that much of the visible accountability and answerability will be lost.  Some will be provided by the London Assembly who will have a new and enhanced role in respect of policing and crime, but their focus – as envisaged by the new statute – will be very much on the MOPC and not on the police service itself.

How this will develop will depend on the personalities involved – both at the MOPC and on the Assembly – and on the willingness of the Met itself to be open and transparent.  There are certainly no guarantees on any of this, yet police accountability in the capital will remain as important as ever – as the events of the last few months have demonstrated.

Perhaps the message is watch this space.”