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Archive for the ‘Local government’ Category

Tuesday
Jan 10,2012

Just in case LibDems in London were in any doubt about Tory triumphalism, the LibDem role as (very) junior partners in the coalition and what the Government’s stance on Europe is all about James Cleverly AM, Leader of the Tory Group on the London Assembly, has spelt it out:

The Indi is running a story about a potential “rift” between Clegg and Cameron over Europe and the veto.  This is such a non-story, Clegg’s position on Europe is well known.  Cameron’s position on Europe has been made clear and is much more in tune with the wishes of the British people.

David Cameron is the Prime Minister and his position is both right and popular.  Nick Clegg is not Prime Minister and his position is wrong and unpopular.  Bets please on whose views will win out.”

Squelch!

At some point, the LibDems are going to realise that their post-General Election sell-out to the Tories is getting them nowhere …..

 
Monday
Jan 9,2012

This Thursday the last meeting of the Metropolitan Police Authority will take place before it is abolished and replaced by the Mayor’s Office for Policing and Crime (MOPC – pronounced “MOPSY”) on 16th January.

The meeting on Thursday is not being held in City Hall and is much more low-key than usual with no written report from the Commissioner and with most of the agenda given over to formal reports winding up the remaining aspects of the MPA’s business.

There is, however, an item grandly-entitled “MPA Retrospective” which you might assume was intended to deal with what the MPA has achieved during its eleven and a half years of existence.

You might assume that, but you would be wrong.

In fact, the report only looks at the achievements “under the current administration” – i.e. since Mayor Boris Johnson and his Deputy Kit Malthouse AM got their hands on the tiller – so it is a record of the three and a bit years when the MPA was Tory-led and ignores the previous eight when its was Labour-led.

I am trying to establish whether this is simply an attempt to save paper (clearly a report that looked at what has been achieved since July 2000 when the MPA took office would be a good bit longer).  I am assured that a “there will be a full retrospective on the website”.  However, it is not there yet and the MPA website will be archived after this coming weekend, so that’s not much help…

Only an extreme cynic would suggest that this is yet another effort by parts of the GLA family to promote the record (sic) in office of a Tory Mayor in advance of the elections next May …..

Interestingly, one claim rather confirms the view that the Conservative tenure has provoked an unusually – and possibly unhealthily -high turnover of senior police officers at New Scotland Yard:

“20. The Authority has, since April 2008, appointed three Deputy Commissioners, 12 Assistant Commissioners, 23 Deputy Assistant Commissioners, and 63 Commanders. The Authority has made recommendations to the Home Secretary on the appointment of three Commissioners.”

 Apparently, that counts as an achievement …..
Friday
Jan 6,2012

David Cameron is on the Today programme banging on about making the NHS more patient-centred and suggesting regular patient-led hospital inspections to ensure that this is the case.

Nothing wrong with this in principle.  Indeed, every successive Prime Minister and Health Secretary in the last sixty years has talked about “putting the patient at the heart of the NHS” or some such soundbite.  Equally, patient-led inspections are an important tool to support such an aspiration.  Indeed, when I was Director of the Association of Community Health Councils in the late-1980s and through much of the 1990s, I was well aware of the importance of unannounced CHC inspections in promoting improvements in patient care at local level and in highlighting wider issues of health policy.

But – and it is a big but – the Government’s proposals for local HealthWatch organisations still fall a long way short of guaranteeing the network of vibrant independent patient-led structures that CHCs (shamefully abolished by the last Labour Government) provided in their hey-day.  There are two big problems with the Government’s ideas on this in the Health and Social Care Bill, currently paused in its long slow grind through the House of Lords.

First, the new local HealthWatch organisations will be creatures of the local authorities in their areas, even though they will be expected to monitor the social care provisions commissioned and provided by those same local councils.  Hardly, independent.

And the national structure, HealthWatch England, will be packed with Secretary of State appointees and will be a creature of the Care Quality Commission (constituted as a CQC Sub-Committee), even though much of the work of HealthWatch may involve calling on the CQC to take action on specific matters and may require criticism of the effectiveness of the CQC itself as a regulator (hardly easy if you rely on that body for all your support services).

And second, the system is likely to be grossly under-resourced.   The Government is planning to “provide” resources for the new local HealthWatch organisations as part of their general grant to local Councils.  No ring-fenced money.  And, at a time when local government is having to make very substantial cuts in their core provision, it is hard to see that this will be much of a priority in any local council’s deliberations.  The evidence in the last year of the way in which the budgets of Local Involvement Networks (LINks – the current iteration of the Department of Health’s attempts to replace CHCs) have been cut – in some instances by as much as 70 or 80% by local councils – does not provide much hope for properly-funded local HealthWatch organisations in the future (especially when they start criticising that council’s own provision).

And, of course, with so much of health and social care taking place outside a hospital setting, the Prime Minister’s comments do suggest a mindset locked in the concept of an NHS that is all about hospital/acute care .  Delivering patient-centred community-based care will require both a willingness to invest properly and sustainably in those aspects of the NHS and also a recognition that patient-led monitoring of those services is not only important too but will also need to be resourced properly.

Without any of that, the Prime Minister’s comments today are nothing but empty soundbites.  So, no surprise there …

Monday
Jan 2,2012

Michael White, the Guardian’s veteran Assistant Editor, has an article today assessing the shape of UK politics over the year ahead.  Although sometimes verbose (a problem I am well aware that I suffer from myself), he is usually extremely perceptive.  Today’s article is therefore well worth reading and I agree with many of his conclusions.

However, there is one line in it that is total nonsense.  After pointing out the threat that reinvigorated Boris Johnson would present to David Cameron if re-elected to the London Mayorality in May, he goes on to say:

“If Ken beats Boris he will make Miliband’s task harder.”

The reality is the exact opposite.  So much so that David Cameron has recognised that his number one priority in 2012 is to ensure that London’s City Hall must remain in Conservative hands.  Not the economy; not the growing housing crisis; not Europe and the Eurozone; but London.  That is the Prime Minister’s priority for the coming year.

Why?  He knows that a Ken Livingstone victory in May would be an essential first step for the Labour Party to win a General Election in 2015.

He also knows that Ken Livingstone’s flair for articulating the impact of Tory policies on the people of London would resonate with millions elsewhere in the country.

The Prime Minister’s grasp on history is probably a little shaky, so he may not be aware that a Labour-run London County Council in the 1930s laid the groundwork for the victorious and reforming Labour Government of 1945: trialling and showcasing how the power of Government can be harnessed to boost the chances of the vast majority of the population.

However, Cameron’s instincts will tell him that a Labour Mayor in City Hall would demonstrate that there  is an alternative to a Conservative-led Government more concerned with the interests of a privileged minority than the rest of society.  (A Conservative trait also shown by Mayor Johnson and his penchant for meeting bankers and representatives of the financial services in preference to other interests in London.)

So if Cameron is so desperate for Ken Livingstone not to be elected in May, it follows that Ed Miliband is, if anything, even keener to see the Conservatives turned out of City Hall in four months time.  This is where Michael White is wrong and dwelling in a 1980s past.  Ken Livingstone has more positive and supportive relations with the national Labour leadership than ever before.

A Livingstone victory will be a boost for Ed Miliband and the Labour Party.  It will be a sign that the people of London have rejected not only a Conservative Mayor but also those Conservative policies being pursued by his friends holding national office.

Friday
Dec 16,2011

Today was the thirteenth full day of Committee discussion on the Health and Social Care Bill on the floor of the House of Lords.  The clauses debated today included a number relating to the operation of HealthWatch England (the national body that the Government is proposing to represent the interests of patients in the new NHS – which is to be constituted rather bizarrely as a sub-committee of the Care Quality Commission) and local HealthWatch organisations (these will be established by local councils – even though one of their roles will be to scrutinise the care provided by those councils).

I spoke in support of a number of amendments designed to strengthen the position of HealthWatch and make it more effective, saying:

“My Lords, we have already debated to some extent the way in which HealthWatch England might operate. However, this group of amendments returns not just to that issue, but to a number of other important issues which go to the core of the extent to which HealthWatch England is genuinely going to be an effective organisation. I give Ministers and the Government the benefit of the doubt on this—that that is something that they want to see happen. Therefore, the way in which HealthWatch England is established, the way in which it functions and the powers that it has are going to be critical to whether or not this body will simply join the long list of organisations that have been set up over the years to represent patients’ interests and have then been dismembered after a short period, or in some cases a slightly longer period, because they are not seen to be effective. If the Government are genuine about putting patients at the heart of the new NHS, then they need to ensure that HealthWatch England and healthwatch organisations are effective.

My noble friend Lord Warner, slightly unusually, pulled his punches. He talked about it perhaps being a major mistake to host HealthWatch England within the CQC. I have to say there is a danger that this could be a disaster. It is a disaster because of the sustained attacks that the CQC is currently undergoing, which seem to emanate in some instances from Government and Ministers who clearly are not satisfied with the direction of travel. There are clearly concerns that this is an organisation which is being asked and expected to do far too much at the moment. To add this additional responsibility is not necessarily helpful.

I can understand that it is important that HealthWatch England relates effectively to the Care Quality Commission: that is one of the organisations it must relate closely to. But it must also relate closely to the NHS Commissioning Board. It must also relate properly, under certain circumstances, to Monitor. Simply saying that the relationship with the CQC is paramount does not necessarily make an enormous degree of sense.

My noble friend Lord Warner made a specific point. If the motivation for hosting HealthWatch England within some other national organisation is to save money—I understand that it may not be the prime motivation but it is a concern in all this—then there are plenty of other ways of achieving those savings in terms of back-office functions. Those functions can be provided by agency agreements; you can have organisations which are in the same building and able to share some of the physical facilities and so on. It does not necessarily require that the organisation sits as an integral sub-committee within or as part of the organisation concerned. You can do it in other ways; you can achieve those savings in other ways.

However, if you place HealthWatch England in the Care Quality Commission, or for that matter in the NHS Commissioning Board or any of the others, you are in danger of there being either a real or perceived conflict of interest. It may well be the case that HealthWatch England will, on occasions, be asking the Care Quality Commission to do certain things. It may well be the case that there will be, on occasions, circumstances in which HealthWatch England will be saying that the Care Quality Commission has failed to do certain things. That is not a happy situation; nor is it one that is likely to engender the trust of the public if they are seen as being part of the same organisation. That is the principle which underpins some of these amendments.

There is then the question of the extent to which HealthWatch England is seen as being a creature of either the CQC or Government. That then relates to how the ruling body of HealthWatch England—the committee, if it is a sub-committee of the CQC—is appointed. That is why one of the amendments to which I have my name, Amendment 307, specifically refers to the committee of HealthWatch England being,

“elected from local Healthwatch organisations”.

It is a principle of accountability; it is a principle of ownership; it is a principle of safeguarding that independent viewpoint and voice. That is why that is necessary and that is why Amendment 307 in this group is so important.

We also have a series of amendments, Amendments 308, 309, 312, 313, 315 and 316, which try to make sure that it is absolutely explicit that HealthWatch England’s role is not just to provide information or advice but, on occasions, to make recommendations to the bodies concerned. It may be a recommendation to the CQC or to the other major national organisations. This group of amendments specifies that that is part of its functioning. It also makes it clear that there should be proper responses to those recommendations from the bodies to whom they are directed. Again, if the Government are serious about making HealthWatch England effective and about having a genuine and clear voice of the users of the NHS and social care services, surely placing in the Bill the power to make recommendations is central to that.

Amendment 314, to which I have also put my name, essentially requires HealthWatch England to provide the CQC with information and advice on the views of patients and the public, and of local healthwatch organisations. It is not a question of it being a discretionary responsibility but a clear responsibility—it “must” rather than it “may”. I know that, in this Committee or in your Lordships’ House more generally, we sometimes get into esoteric discussions about the relative force of “must”, “shall”, “may”, and so on and so forth. I am quite clear that must is stronger than may. That is to avoid a situation where the national body fails to take into account the views and opinions being expressed locally. It is saying that this is an obligation on the organisation to reflect that. Again, if you want to see an independent voice for patients at national level, it must be clear that that body is obligated to put forward the views of patients, the public and local healthwatch organisations.

Amendment 317 also goes to the heart of the relationship between HealthWatch England and local healthwatch organisations. It is a very simple expectation, which I am surprised was not included in the Bill already. HealthWatch England must send a copy of any report it produces to all local healthwatch organisations. This is about the way in which local healthwatch organisations relate to their national body. I speak as someone who ran a national body for patients for a number of years. I know that we would have had an extremely difficult time with our member community health councils had we been making advice and recommendations at a national level without keeping the local organisations, on whose advice those recommendations were based, fully informed of what we were saying and doing. The Bill sets out some of the people who should receive the reports produced by HealthWatch England, but fails to mention local healthwatch organisations. It is a simple change. I am sure it was a mere error in drafting and that the Minister will be able to accept Amendment 317 without wasting time at Report on the issue.

Amendment 318 relates to the relationship between the Secretary of State and HealthWatch England. Clearly, there is a nagging concern in the Department of Health that HealthWatch England may not do all that the Government are hoping, which it certainly will not be able to do unless they make some of the changes being suggested in this group of amendments. However, the Secretary of State has taken upon himself the power to give directions to HealthWatch England. Personally, I do not have a problem with that. I accept that Secretaries of State like to have that in respect of all sorts of organisations. However, before making those directions, which the Secretary of State should not make lightly, Amendment 318 provides that the Secretary of State,

“shall consult local Healthwatch organisations”.

If the Secretary of State were to give a direction on the basis that it was failing to discharge its functions, that should be in the light of the knowledge that local healthwatch organisations, to which HealthWatch England should be responsible and is, in part at least, servicing and supporting, have been properly consulted.

I think that the amendments are entirely modest, sensible and ones that the Government can accept without further problem. They are integral to ensuring that HealthWatch England is the proper voice of the users, patients and those who depend on the NHS.”

The response from Baroness Northover (who apparently still resents the way in which I defeated her in an election in my ward in Haringey in 1998*) was not exactly encouraging – so much so that she sustained – in House of Lords terms – quite a robust battering from myself and Labour colleagues:

Baroness Northover: My Lords, this has been another excellent debate. We have returned to the topic of HealthWatch, which we also discussed on 22 November. I listened very carefully to the views expressed in that debate. It seemed that there was a consensus, as there has been again today, about the need to have the patient voice very much at the heart of the NHS. There was agreement then, as I think there is today, that the Bill moves us forward in making sure that the patient voice is at the heart of the NHS. I thank the noble Lord, Lord Warner, for his comments in this regard.

However, I fully recognise that there are significant concerns about the way in which the Government are taking forward these proposals. When we discussed this previously, I made a commitment to continue discussing these issues. We have had subsequent meetings, which some noble Lords have attended; I thank them for their input. I found those meetings extremely constructive. I also attended the meeting between the noble Earl, Lord Howe, and the national association.

Our previous debate focused on the independence of HealthWatch England, which will be a statutory committee of the CQC. I understand that this risks, as the noble Lord, Lord Harris, said, dangerously compromising the independence that I talked about as being so important. Let me be clear why we are proposing this arrangement. There is a reason why, at present, there is no national statutory organisation to champion the patient voice. The last body, to which noble Lords made reference—the Commission for Patient and Public Involvement in Health—was abolished for being ineffective and lacking influence as well as being too expensive and too centralising. To quote from the Health Select Committee’s 2007 report into Patient and Public Involvement in the NHS:

“The evidence we received was overwhelmingly critical of the Commission”.

The noble Lord, Lord Warner, said that the Government should set up an authoritative, stand-alone body, and others have made similar points. This is, however, precisely the point. While I respect the view of the noble Lord, the Government have not been convinced that it would be possible to have such an authoritative stand-alone body in the form that they suggest. The previous Government’s attempt to do this with the commission did not work out well, as noble Lords know. The abolition of the commission was announced five months after it started work. It limped on for a further three years, chewing up £100 million and was universally criticised.

Lord Harris of Haringey: Bandying around figures—“it chewed up £100 million”—gives a completely misleading impression. Could she tell us what proportion of that £100 million was the administrative cost of the commission, as opposed to the provision of patient and public involvement forums in every part of the country? The figure of £100 million is totally misleading.

Baroness Northover: I suggest that the noble Lord talks to his noble friend Lady Pitkeathley about some of the details.

Lord Harris of Haringey: I suggest that if you use a figure like £100 million, which was not the figure used by the noble Baroness, Lady Pitkeathley, you need to explain that that includes the running of the public and patient involvement forums. It is not the cost of the administration of the national body itself.

Baroness Northover: The organisation used up £100 million. There were criticisms from the local organisations that they were not getting the money they needed, so there was widespread criticism. There was criticism at a national level within the NHS and, in particular and importantly, the local organisations did not feel that it was acting in the way they needed it to, or feeding through to them the resources they needed to do what they felt was appropriate.

Lord Harris of Haringey: One of the failings of the commission was that it did not have a relationship with local public and patient involvement. The purpose of the amendment which talks about direct election would be to obviate that problem and provide a constraint in terms of whether or not there were going to be overly centralised administrative costs, because the body itself would be accountable to the local bodies that would be the recipient of most of them. My concern and my frank irritation with the commission—which I had no part in at the time—was the suggestion that all the £100 million was somehow used by the central administration. That was not the case.

One of the failings of the commission was that it was not accountable and did not have a proper direct relationship with local public and patient involvement. That was a fault both of the way it was constructed in terms of the legislation, for which the Labour Government of the time must take responsibility, and of the way in which the commission chose to work, with the support of the Department of Health at that stage.

Baroness Northover: What the noble Lord has said bears out the point. This was a nationally established commission which we all agree did not work. We therefore need to learn from that costly experience to try to move on and to work out a way in which you can have local healthwatch organisations as the local eyes and ears, feeding through to HealthWatch England, a national organisation. We are at the moment looking at how that national organisation should be sited. Everyone has said that the relationship between the national organisation and local organisations did not work previously. We are seeking here to make that relationship work much better. I can see another noble Lord is about to hop up.

Lord Warner: The Minister will be pleased that it will be the noble Lord who pulls his punches, as my noble friend said earlier. I wish to pursue this issue of how much money the Government think they need to spend on funding HealthWatch England. This is the real issue: say, for example, it has £10 million—I do not know what figure is being considered, but there will be a sum of money. It seems to be agreed that there ought to be some kind of national body. I do not altogether understand the Minister’s argument that we got it wrong in the past, because we fully accept that we got it wrong. However, it does not follow from that there should not be a national public body called HealthWatch England. The Government seem to accept that. The argument is over whether you should place that body in the Care Quality Commission. I can see that one might argue that costs could be reduced by doing that, but we first need to know what the Government are prepared to spend on this body, and then we can discuss the best way of spending that money in terms of independence.

Baroness Northover: Perhaps I may come on to the points that I was going to make regarding why we are making our proposals in light of the experience of the national organisation that did not work brilliantly. They address some of the issues that the noble Baroness, Lady Pitkeathley, raised and are implicit in the points made by the noble Lords, Lord Warner and Lord Harris, and others about the independence and status of the new organisation.

I cited what happened with the previous national organisation, and the point about where we are placing HealthWatch England is that it is an attempt to ensure that it is in a strong position to influence the regulator, the CQC, rather than sitting off to one side and not necessarily being listened to. A lot of concern has been expressed about how that relationship would work, but I point noble Lords towards the other side of the issue. If HealthWatch England is sitting there alongside the CQC, with local healthwatch feeding into HealthWatch England, what better way to make sure that you flag up to the regulator concerns from local areas. Noble Lords should try to look at the issue from that point of view, as opposed to seeing the CQC as somehow silencing HealthWatch England. It is vital that the views of patients and other service users are taken on board by the CQC and that it does not close its ears and eyes to what is happening.

Lord Warner: I am still struggling. I am sorry to keep interrupting the noble Baroness, but let me give her an example. Could HealthWatch England, as a sub-committee of the CQC, run a national campaign against what is being done by that regulator on an issue such as feeding elderly people in hospital?

Baroness Northover: HealthWatch England has a statutory obligation to represent the position of patients and, if it is concerned about the feeding of patients, yes, it indeed has the right to set its agenda, to campaign on that and to argue that this must be checked on and brought up to a much better standard. As my noble friend Lady Cumberlege said, we have throughout the NHS and through its recent and long-term history, problems and challenges in meeting basic standards of care and attention. All of us know that, whatever party we come from. The previous Government did not get this right; we are seeking to move forward, and we need to ensure that we consider these questions fundamentally and address why these problems continue to arise. They have been intractable; we will continue to address them; I welcome noble Lords’ contributions on that.

Lord Harris of Haringey: The noble Baroness made a very important point just now. She said explicitly that HealthWatch England could and should be a campaigning organisation, although it would be a sub-committee of the CQC. This is irrespective of the debate about where it is located. I think that the principle of creating a national patient organisation as a campaigning organisation on behalf of patients is extremely important. I am very grateful to the noble Baroness for making that commitment on behalf of the Government.

Baroness Northover: HealthWatch England will represent the voice of the patients. It will publish on that; it will advise on that; to take up a point raised under one of the earlier amendments, it will no doubt make recommendations within the areas of its advice. It has the obligation to make those recommendations to various organisations within the NHS. Various organisations, including the CQC, have the responsibility to respond to that. All those obligations will flag up problems, so I do not see that I have made a startling admission. I would have thought that the noble Lord, Lord Harris, would know that transparency—publishing information—was the best way forward.

However, I agree with many noble Lords that this has been rather a patchy area. We have to try to give greater strength to these organisations both locally and nationally. Much of that is not based on their structures, because all sorts of structures have been tried, but we are trying to take them further forward.

Lord Warner: I just want to pursue the issue of the campaign, because it is very important. Currently, there has been a very effective campaign about literacy run by the Evening Standard. That has attracted lots of voluntary money to run it and led to some interesting changes and the Government supporting it. To be absolutely clear, I ask: are we saying that a sub-committee of the regulator—the Care Quality Commission—could run a campaign on the feeding of elderly people in the National Health Service in association with a national newspaper and criticise the Government strongly, implicitly, about the way that they are running the NHS in that area? If the Minister, on behalf of the Government, is saying that yes, it can, I start to get more convinced about the Government’s commitment to independence of the sub-committee of the CQC.

Baroness Northover: As I said, HealthWatch England will need to look at what works well and what works not so well right across the country, gathering the information from local healthwatch. It will flag up things which, no doubt, will be uncomfortable at all levels of the NHS and the Government. Noble Lords would not expect change to be driven in any other way. If things are unsatisfactory locally, as fed by local healthwatch to HealthWatch England, if it is doing its job it will obviously flag up areas where change is required.

Lord Warner: I am not talking about flagging up; I am talking about a campaign. A campaign means that you take action, using the media, to put serious pressure on the Government in relation to their record in running the NHS for elderly people. I am not saying that that should happen; I am trying to understand what power this body would have as a sub-committee of the regulator, which is the point that we are discussing.

Baroness Cumberlege: Does the noble Lord, Lord Warner, agree that much depends on the membership of this body and whether it is independent? I am not sure why people call it a sub-committee. In the Bill it is called a committee. I have chaired the top board in organisations and I know that you get very close to some of those committees—you listen to them. If an organisation is totally independent and it goes left field, making a whole lot of noise, you just dismiss it and say, “Oh, they’re always making problems”. The opportunities are far greater if part and parcel of what it does is informing you of what is going on. I honestly think that you will listen much more carefully to people whom you meet in the corridor, in the chambers or wherever the debates are going on.

I take the point made by the noble Baroness, Lady Emerton. The Care Quality Commission does not always say that everything is dreadful. The Healthcare Commission used to say, “This bit’s good; this bit needs addressing”. I can see that this committee—not sub-committee—of the Care Quality Commission will serve a very useful purpose. It could put enormous pressure on the Care Quality Commission really to understand what is going on and it would not just be an irritant that is offside.

Baroness Northover: I thank my noble friend Lady Cumberlege for that and I agree with her very much. We all wish, and have all sought, to drive up quality in the NHS. That is so often difficult to achieve but this is one of the means by which we hope to make that happen. No doubt some people will be made to feel uncomfortable by what the committee reports and says, and I hope that that will be the case.

Baroness Pitkeathley: Perhaps the noble Baroness can take that a little further. For example, could HealthWatch, in the position envisaged for it by the Government as a committee of the CQC, join with a national campaigning charity—I am thinking of something such as National Voices—to put pressure on the CQC itself about how it was reporting patient outcomes?

Baroness Northover: I am sure that it could. If it felt that it was not managing to persuade the CQC or some other part of the NHS to do what it considered to be in the best interests of patients, then I am sure it would go to greater lengths to ensure that it got its message across. It is very important that we have a louder patient voice within the NHS, and this is one means of seeking to achieve that.

I return to some of the amendments that noble Lords have flagged up. This is a very important debate. I think we agree on where we wish to head and what we are seeking to achieve, but I hear noble Lords’ concerns about whether this is the right way of going about it. Noble Lords talk about an independent organisation and so on but that route was tried. This is another route for trying to make sure that there is a body close to an organisation which itself must have a major role in driving up quality. The synergies there are very important.

The question was raised of how local healthwatch is going to influence HealthWatch England. I heard what the noble Lord, Lord Harris, said about elections to HealthWatch England from local healthwatch. Clearly, as my noble friend Lady Cumberlege said, a great deal will depend on who is on these organisations nationally and locally, and it will be necessary to ensure that they are as strong as possible. The Secretary of State will determine how the membership is comprised through regulations and we will be discussing with a wide range of stakeholders the contents of those regulations. I can confirm that we will discuss the suggestions put forward by noble Lords. We had from the noble Lord, Lord Harris, an emphasis on election and a concern about that route from the noble Baroness, Lady Pitkeathley. Both noble Lords might wish to feed in to how those regulations are taken forward so that we can best comprise HealthWatch England and local healthwatch.

Lord Harris of Haringey: Can the Minister indicate the timetable for consultation on the content of those regulations? Those of us who wish to see an election process in the Bill will need to know sooner rather than later whether that is the way in which the Government’s thinking is going. When is that consultation going to take place and when is it likely to conclude?

Baroness Northover: In the meeting that I was in yesterday with NALM this was an issue. The noble Lord, Lord Harris, is probably aware of that. No? That was one of the issues—perhaps the noble Lord, Lord Warner, referred to it—that did come up. The consultation will be early next year. Given that we are almost in next year, that is pretty soon.

The noble Lord, Lord Harris, wanted to make sure that HealthWatch England’s annual report was shared with local healthwatch. While we do not feel that that is a matter for the Bill, the annual report must be published. It is important that that information is made widely available. I am sure that the noble Lord’s suggestion will be noted by HealthWatch England and local healthwatch as the information between the two must go back and forth, in both directions.

Lord Harris of Haringey: The Bill does not refer just to the annual report. It refers to all reports.

Baroness Northover: It is clearly important that the information goes back and forth between the local and national organisations.

If HealthWatch England were significantly failing in its duties, the Secretary of State has powers to intervene. An amendment addressed whether the Secretary of State should consult local healthwatch. This was on the assumption that HealthWatch England was in effect failing local healthwatch. While the Secretary of State should not be bound into a rigid consultation—something else entirely could be in question here—we would fully expect him to seek the views of others where appropriate in coming to a decision to intervene. I hope that that will reassure noble Lords.

My noble friend Lady Jolly talked about local healthwatch needing to look widely at all groups of patients, including those with rare diseases and so on. She is right. We will be coming on to other amendments where we look at this a bit more. LINks and its predecessors recognise that they have not had as wide a coverage as they would like or been as representative of their communities as they would need to be. This concerns us. The noble Baroness, Lady Pitkeathley, referred to it briefly in relation to whether local healthwatch should elect to HealthWatch England. We are seeking to learn from this. We want to try to make sure that local healthwatch has as broad a spread as possible. It is worth bearing in mind that it has a place on the board of the health and well-being boards and so there will be information feeding back to local healthwatch from the others on the health and well-being boards and from local healthwatch into the health and well-being boards. We will come on to local healthwatch in relation to local authorities, but there is synergy there too.

While I feel that the Bill provides safeguards for the independence of HealthWatch England within CQC, I would like to repeat my commitment that we are prepared to listen to further views. It is very clear that we are all trying to head in the same direction. There is a variety of views about how best to do this. We would welcome noble Lords’ continued input as we take this further forward. In the mean time, I thank noble Lords for flagging up these issues. I hope that the noble Lord will withdraw his amendment.

Lord Warner: My Lords, this has been an interesting and spirited debate. I will certainly reflect on the Minister’s willingness to consider some of these issues further. My noble friend Lord Harris and I will certainly be considering this further and I would not rule out the possibility that we might come back to this on Report. I beg leave to withdraw the amendment.

Amendment 306 withdrawn.”

 

*For the record the figures were:

Toby Harris (Lab)                         846 votes Elected

Catherine Stafford (Lab)               806 votes Elected

Lindsay Northover (LibDem)         293 votes Not elected

 

Wednesday
Nov 23,2011

Yesterday also saw the first discussion of the role of HealthWatch during the Committee Stage of the Health and Social Care Bill.  HealthWatch is the proposed new structure to represent the interests of patients and the public in the new NHS.  It is potentially hugely important, as patients will need a strong voice to protect their interests.  However, the Government is proposing that the national body, HealthWatch England, should be constituted as a sub-committee of the regulator, the Care Quality Commission, and that local HealthWatch organisations should be run by local authorities (even though they will be responsible for some of the social care services that HealthWatch will be monitoring) without any protection of their budgets.

This is what I said on the subject:

“My Lords, I apologise to my noble friend Lord Patel if he in any sense felt beaten up by me. I absolve my noble friend Lady Wheeler from any involvement in that process. I also apologise to the long-suffering officials in the Government Whips Office. If my robust style is mistaken, they should really see what I am like when I am angry.*

I added my name to a number of amendments in the various versions of this group. I also proposed Amendment 305. If the noble Baroness whom I believe is replying to this debate is planning to highlight any technical flaws in that amendment, I should point out that I drafted it myself. Therefore, it no doubt does contain a number of technical flaws. But the purpose of the amendment is to assess the feeling within the House and the strength of feeling in the department about the extent to which it is important that HealthWatch England and healthwatch organisations at local level should be independent.

The principle underlying this group of amendments is straightforward-the centrality of the voices of patients and users in the NHS. That voice must be, and must be seen to be, independent of the various provider and regulatory interests. That is what underpins all of the different amendments.

I find it difficult to understand how the Government will oppose the amendments. They keep telling us that the voice of the patient and the user will be central to all these arrangements. They say that that is their intention. But they must be aware, because everybody else is, of the cynicism and doubt that is being expressed around the country about this whole package of NHS changes. Therefore, they should be able to reassure patients and users that their voices will be heard at every level within this complicated restructuring that will take place. That is extremely important.

What is more, it will be important for that voice to be seen to be independent. Members of the public will be concerned about what is happening. They will worry whether their doctors, who that they do not fully understand as being part of commissioning groups, will somehow be making judgments about their care, influenced by financial interests. They will want to be assured that they can go somewhere for proper advice and support, and that that place will genuinely be independent of all of those interests.

A huge expectation is now being placed on local healthwatch organisations. They are expected to provide that independent advice and information, to be able to monitor the nature of the service at local level and to be able to comment on the various changes that are taking place and on the proposals that are coming from the plethora of commissioning groups, senates and goodness knows what else we are going to have. They are going to be there to make recommendations. So, there will be enormous expectations on behalf of the public as to what these groups are going to do. Similarly, the national body, HealthWatch England, will have enormous expectations upon it. That is why it is so important to get these arrangements right. The

proposals for HealthWatch England and local healthwatch are an advance on what we have at present in terms of LINks. There is no question about that-they are a step forward. The record of successive Ministers and Governments in terms of patient representation in the NHS is not very good. This is a step forward from where we are at the moment. So, let us try to get it right. Why not deal with what are comparatively small issues in terms of how the system works?

The trouble is that, at the moment, the arrangements that the Government are proposing are flawed in two key respects: first, on the issue of independence, as the noble Lord, Lord Patel, has already indicated; and secondly, in terms of the resources available. Let us consider for a moment the position of HealthWatch England as a sub-committee of the Care Quality Commission. That might be a very neat way of not increasing the number of quangos by one; it may be that was the sole motivating feature. However, the reality is that it dangerously compromises the independence that I talked about as being so important. Often, HealthWatch England will have to say, on behalf of local healthwatch organisations, that the regulator should be doing something, has failed to do something or has been inadequate in the way that it has done that. In the last few weeks, we have seen the Minister’s colleagues in the Department of Health making quite critical comments about the way in which the CQC has fulfilled its remit. If Ministers are saying that-and Ministers are, after all, the paymasters of the CQC-what is it going to be like for those people whose remit is to raise these issues but are themselves subordinate to that regulatory body? It is going to be a real conflict and a very difficult position for them. The nature of that relationship-the fact that they are a mere sub-committee and are subjected to all of the panoply of arrangements that go with that-is going to be seriously limiting.

I am aware that the CQC is making enormous efforts to try and demonstrate their good faith in all of this. I am sure that the individuals involved have good faith as far as this is concerned. However, we are here considering legislation that will set those arrangements. Once those arrangements are set, the good will of the individuals who may be trying to make it work at the moment may not persist-not because those individuals will change their minds, but because, over time, those individuals will move on and others will take their place. Budgetary and other pressures on the CQC will rise. The feeling that they do not like being criticised by a body that is technically subordinate to them will increase. That is why that arrangement does not work.

There is an even stronger argument as to why local healthwatch organisations should not be subordinate to principal local authorities in their area. The Government’s flaws here are flaws twice over. Not only are they imperilling the independence of local healthwatch organisations by saying that-even though they are supposed to be independent-they are creatures of the local authority, the funds will be provided by the local authority and many of the facilities may well be provided by local authority but, because the funds will not be ring-fenced, it will be far too easy for local authorities to start to apply the screws if they do not like the criticisms that come from it.


A major conflict of interest is being created. HealthWatch cannot be accountable to, and at the same time funded by, local authorities because the bodies which commission and provide the services are the local authorities in many instances. However, the Government are saying that HealthWatch can advise members of the public about those services. How can HealthWatch organisations be funded by the same bodies that are commissioning and providing those services? This is precisely the area where the confidence of members of the public and of individual patients is so important. They have to go for advice to a body which is funded by the people about whom they wish to take advice. That hardly looks independent or satisfactory. If HealthWatch is made accountable to local authorities as the Bill proposes, the public will, frankly, have no confidence in that and all the efforts that the Department of Health and the Government have made to try to create a better structure will be wasted. That resource will be wasted because the public will not have confidence in these arrangements.

There is also a failure to protect the funding. I do not know how many hot coals Ministers in the Department of Health had to crawl over to get £60 million out of the Treasury for HealthWatch. I am not suggesting that the Department for Communities and Local Government is any more evil than any other government department, but if you hand the funding to that department, which then hands it on to individual local authorities without a label saying, “Not only is this money to be used for HealthWatch but it cannot be used for anything else”, my experience as a former council leader tells me that you cannot guarantee that the money will be used for the purpose that you wish.

I spoke earlier about localism and said how wonderful it was that the Government should devolve responsibility for this issue. However, it is not a wonderful example of localism if you expect something to happen, you pass the money on and then you are shocked if the money is not used for that purpose. If you want the money to be used for a particular purpose, you have to label it and ring-fence it. However, the Government will not do that. They say that they cannot do that as it would be inappropriate in the spirit of localism.

I have received numerous e-mails and messages from LINks on this very subject. Their experience of not having ring-fenced budgets this year is salutary. One message states:

“As a LINk our funding was reduced by the local authority by 65 per cent this year”.

Another states:

“I have spent 30 years as a senior business professional and business consultant and it is ludicrous to set an organisation targets to be funded by set criteria and then reduce those funds by 65 per cent. This makes a mockery of the organisation’s ability to carry out its public remit”.

That is what is happening at the moment. What guarantees can the Government give that it will not happen in the future?

There is a technical point here. The Department of Health has presumably secured these funds through the comprehensive spending review. Who will own those funds the next time that the comprehensive spending review is negotiated? Will it be the Department


of Health or the Department for Communities and Local Government? If it is the Department for Communities and Local Government, how will it rank given its other priorities which have nothing to do with HealthWatch? If it is the Department of Health, how will it answer the question from the Treasury, “How do you know that this money is being spent in the way that you intend?”. It will not be able to answer that question, as I suspect that the correct answer is that the money will disappear. LINks already have huge concerns about the resources question.

The other element of this concerns what sort of patient representative mechanism we want. Do we want something which is top-down or something which comes from local organisations? The amendment that stands in my name seeks to establish an arrangement whereby local healthwatch organisations have ownership of the national body which speaks in their name. I believe that that is essential. Even if you created HealthWatch England as an independent structure without the problems of it being a tool of the regulator, you will still not get the necessary buy-in at local level unless local organisations feel that they are part of it and have a say in its organisation. I speak as someone who was director of the Association of Community Health Councils for England and Wales for 12 years, and I know how important it was for the member organisations to feel that what we were saying as the national body reflected-not to the letter, but reflected-what they felt was important as local organisations. If you do not have that mechanism, if you do not have that process built into the legislation, I am afraid that you will create a gulf between the national body and the local bodies. That is surely unsatisfactory.

The Government’s proposals could make an enormous difference to patient representation in the new NHS, and patient representation is going to be enormously important in the new structure, because I think that many patients will feel disempowered and worried by what is happening. However, those arrangements are flawed unless the Government accept the spirit of the amendments in this group-and unless they accept that HealthWatch, both nationally and locally, should be independent, and that resources should be clearly ring-fenced and clearly identified and cannot be used by bodies that have no interest, necessarily, in patient representation used for other purposes.”

*This relates to a procedural manoeuvre instigated by the Government late the day before that I thwarted.

Tuesday
Nov 8,2011

Ben Brogan, the Daily Telegraph’s Deputy Editor, is fed up with the tent protest at Parliament Square. 

And what is more, he is fed up with Mayor Boris Johnson’s failure to sort it out:

“Well, those of you who have long wondered about that ghost town of dirty tents lining two sides of the square might have a look at this video, which we filmed a few days ago. We used a thermal camera in the same way we did at the St Paul’s protest. If anything the result is even more damning. Turns out the ‘peace camp’ looks deserted because… it’s deserted. MPs might like to ask why the Met/Westminster Council/Boris Johnson don’t pop round and take these abandoned articles away. Either that or stop bullying us about left luggage and locked bicycles being destroyed. The Mayor should get down there this afternoon with a van and clear the lot himself.”

Strong words: “get down there this afternoon”.

Is even the Daily Telegraph beginning to realise that the Mayor needs to get a grip?

Running London is not about sound bites and photo ops – it is about doing things for London and Londoners.

Whether Londoners agree with the Daily Telegraph’s fixation about tented protests or not, they do agree that London needs a Mayor who takes the job seriously and really does care about the city.

Friday
Oct 28,2011

The protesters encamped outside St Paul’s Cathedral are issuing a statement of demands later today.

And it is clear from the draft that is being circulated that the stand-off with the police is getting personal.

The draft states that the protesters want to see “the decommissioning of the City of London police with officers being brought under the jurisdiction of the Metropolitan police force.”  A demand with which I personally have some sympathy.

However, it is hardly the sort of proposal likely to endear them to the police who may be charged with evicting them.

And why do they think they would fare so much better if the HULK was in charge?

Monday
Sep 26,2011

The Liberal Democrats have already advertised for potential candidates to stand as candidates for the new posts of Policing and Crime Commissioners that are to be elected in November 2012, even though conventional polling wisdom suggests that none of their candidates are likely to be successful in the forty-one contests that will take place – even using the Supplementary Vote* electoral system.

Apparently, there is a major debate going on in the Conservative Party as to whether to field Tory candidates at all with a strong preference from some quarters for the Conservative Party to “endorse” (and campaign for?) so-called “independent” candidates.

What is disturbing is that I hear that there are some senior Labour figures who have similar ideas.

I have raised this now at a couple of fringe meetings.  At all the meetings I have been at there has been unanimous support for my strongly-held view that these will be extremely important elections for very powerful posts that the Party has a duty to contest.  I am not against independent candidates emerging, but the danger is that such individuals will be unknown quantities whose effectiveness and fitness for office will never have been tested.  Internal political party processes (although by no means perfect) do at least provide a mechanism for such testing.

Interestingly, when I raised it this morning with Vernon Coaker MP, the Shadow Policing Minister, he strongly endorsed my position and said he would argue for it, but then wryly commented that the Party decion-making process on such issues was sometimes rather strange – an implicit confirmation that someone somewhere is actively considering a non-contest option.

 

 

 

* Under the Supplementary Vote system electors cast two votes, one for their first choice candidate and one for their second choice candidate.  In the first count all first choice votes are counted.  If no candidate has an absolute majority, all but the top two candidates are eliminated and the second choice votes of those whose first choice candidates have been eliminated are then counted and where applicable added to the tally of the top two candidates.  The candidate with the greater number of votes is then elected.

Friday
Sep 23,2011

I am not getting too excited about it – in fact, I am not getting excited at all – but “Total Politics” have been publishing their latest ranking of political blogs in the UK.  This year, the arrangements changed requiring a lot more effort from those who wanted to vote and I don’t know what that did to the level of participation in the exercise, as the background data is not published.

However, for what it is worth, this blog has been rated as 228th in the list of the top three hundred political blogs in the UK.  Apparently, this is an upward move: I was (although not aware of it) in 271st place last year.  At least, I am above Lynne Featherstone who comes in at 252nd.

The blog is also 33rd in the list of the top one hundred Labour blogs and personally I am 87th in the list of the top one hundred Labour bloggers (this is presumably not a bad result as David Miliband is at 72nd place and Ed Balls at 73rd with Tony Benn in the 90th spot).