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Archive for the ‘London’ Category

Tuesday
Mar 20,2012

My webmaster, the excellent Jon Worth has posted on the row that has developed about Boris Johnson usurping the Mayor of London Twitter account for his political campaign.

And as usual he talks a lot of good sense:

“The issue here essentially boils down to your answer to one question: is there any longer any point in insisting on the separation of party political and governmental (i.e. supposedly impartial) communications?

If your answer is that there is still a need for a separation, then Boris is clearly in breach of the rules. The Twitter account in question was established after the 2008 elections, staff time from officials at the GLA was used to maintain it, and – prior to the username change – the account was prominently displayed on the GLA website, a site maintained by the administration that is supposedly above party politics.”

He even offers a solution:

“It would actually not be hard to separate the party political and administrative comms for someone in Boris’s position. A party political, personal Twitter account could be maintained by the politician and his political staff (even if these are taxpayer funded – i.e. SpAds and equivalents – and you could even make the case for there being more of them), and linked to the politician’s political website. A further administrative account (@LondonGov or something like that in this case) could then be used for the governmental comms. If the political account chooses to RT something from the governmental account, so be it, but the administrative account would not RT the political account. When the politician leaves office, his/her followers stay with him/her, while the governmental followers transfer to the next administration. Everyone would know where they stand. Too much to ask?

As for the Boris Johnson case: the account should be returned to the GLA and should not be used by anyone during the election campaign as resources from the impartial administration have clearly been used in its creation, production of content, and increasing its reach, and the two account solution put in place thereafter (of course applying to @ken4london and not Boris!)”

The episode, of course, has displayed an arrogance and a belief that rules are for other people – which it could be argued has been something that the present Mayor has displayed though out his life.  Of course, it may not be a personality trait that uniquely applies to Boris Johnson, it may be the case for other Old Etonian Tories ….

 

Sunday
Mar 18,2012

According to Andrew Rawnsley in today’s Observer, David Cameron has vetoed the introduction of a mansion tax so as to try and avert a defeat for Boris Johnson in May’s Mayoral elections in London:

“The Lib Dems are not going to get their mansion tax and probably knew from the start that the Tories were unlikely to be persuadable. George Osborne could see the intellectual case for taxing wealth via property and some Treasury officials were attracted to the simplicity of a tax that would be hard to avoid. The chancellor might have been willing to cut a deal with the Lib Dems, but the prime minister was not. David Cameron feared the reaction of Tory MPs and the Tory core vote, among whom are rather a lot of people living in the size of property that would attract the tax.  …  He also had a rather cruder, short-term electoral consideration that has been surprisingly overlooked in all the debate about the pros and cons of a mansion tax. Many of the homes worth £2 million or more are concentrated in London. There is an election for mayor of the capital coming up very soon. David Cameron did not want to do anything that could be said to jeopardise Boris Johnson’s chances of beating Ken Livingstone. The first thing that a defeated Boris would do would be to try to get back into the Commons, which is the last place that Mr Cameron wants to see his fellow old Etonian. A beaten Boris will be bad enough for the Tories; a martyred Boris able to blame his defeat on the prime minister and the chancellor would be much worse for them. So the mansion tax was blocked.”

 Good to know that personal intra-Party considerations trump everything else.

 

 

Friday
Mar 16,2012

Just over a month ago the Government yet again snubbed the Mayor of London over his proposals for a pilot sobriety scheme, 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.

But now – either because they have finally listened to the overwhelming force of arguments coming from all corners of the House of Lords or because they want to provide a helpful headline to the Mayor prior to the Mayoral elections in seven weeks time – the Government has performed an 180° u-turn. They have now tabled an amendment to the Legal Aid, Sentencing and Punishment of Offenders Bill that will enable the courts to impose sobriety orders as part of a suspended or community sentence.

Offenders would have to wear ankle tags that continuously monitor alcohol levels, for up to four months.  The orders would allow alcohol levels to be monitored either by these tags which test sobriety every half hour, or by requiring offenders to attend a police station daily – or at other regular intervals – to be breathalysed.

Of course, the other advantage from the Government’s point of view is that it saves a lengthy debate on a Bill that is already taking much more time to progress through its various stages in the House than expected.  And what is more it avoids the certainty of another defeat for the Government to add to the nine they have already had on the Bill so far in the Lords.

It is really a case of Healey’s Law: when in a hole, stop digging.

Tuesday
Mar 13,2012

An exchange in the House of Lords this afternoon demonstrated that following the election of Police and Crime Commissioners public police accountability is to be done on the cheap.

Baroness Ruth Henig asked how much money was to be made available for Police and Crime Panels (these are the new bodies set up under the Police Reform and Social Responsibility Act to hold Police and Crime Commissioners to account and which will in effect be the only public forum in which policing decisions can be questioned).  The answer was £53,300 per panel.

When I pointed out that this would be insufficient to employ more than one or two people to support busy local councillors fulfil their scrutiny role, I was told that perhaps I didn’t understand how local authorities work.  This produced loud guffaws – not recorded in Hansard – as colleagues around the House seemed to think that my twenty-six years of experience in elected local and regional government might be rather more extensive than that of the Minister.

The full exchanges were as follows:

 

Police and Crime Panels

Question

2.44 pm

Asked by

To ask Her Majesty’s Government how much money they will make available to each police and crime panel to cover start-up and first-year running costs.

The Minister of State, Home Office (Lord Henley):My Lords, we are committed to funding police and crime panels to do the job set out for them in the Police Reform and Social Responsibility Act. We will be providing annual funding of £53,300 per panel as well as an additional £920 per panel member per annum for expenses.

Baroness Henig:I thank the Minister very much for his response. One of the few things we all agreed on when the police and social responsibility Bill was before the House was the need for these panels to be strong and to operate as effectively as possible under the new governance arrangements for the policing landscape. Does the Minister not agree that these panels will want to meet regularly, probably at least once every other month; that they will have extensive legal and financial needs; that they will need good financial and legal advice; that they will certainly have extensive training requirements in the first year to enable them to operate effectively and cohesively; and that, therefore, the sums he mentioned are totally inadequate to get these panels operating as we would like in the first year?

Lord Henley:My Lords, I do not agree with the noble Baroness at all. As the Bill went through, we made the function of the panels quite clear: it should be that of a light-touch approach. We then announced how much money would be available for them, which was £38,300 per year each. We have reviewed that figure in the light of various amendments made to the Bill, particularly some that originated this House. The figure, as I have just announced, has been increased to £53,300. We think that that is enough for the panels to do their job. The noble Baroness ought to remember that these panels are not replacing police authorities; their job is to review the actions of police and crime commissioners.

Lord Imbert:In the light of those who have said that they will now put themselves forward as police and crime commissioners, are the Minister and the Government content that they will not bring party politics to bear on policing operational decisions?

Lord Henley:My Lords, I am sure that politics will not come into this, but there will be some people who will stand under party colours. However, that does not mean they will necessarily bring politics into this matter. The noble Lord is going slightly wide of the Question, which is about the panels. The important point is to differentiate the job of the police and crime panels from that of the police and crime commissioner.

Baroness Hamwee:My Lords, even with a light touch, the panels will have to get to grips with a lot of paperwork and information, and undertake a lot of discussion in order to carry out their job of scrutiny properly. If the amount that is to be provided is insufficient, will members be expected to look to their own stretched local authorities for professional and technical back-up?

Lord Henley:My Lords, as I said in answer to the first supplementary question, we have increased by some 40 per cent the amount available to the panels in the light of discussions and thoughts we have had following the passage of the Bill. We believe that it will be sufficient. If individual local authorities wish to spend more, it will be for those authorities to make that decision themselves.

Lord Hunt of Kings Heath:My Lords, the noble Lord will be aware that the police and crime panels are the only check and balance on the potential politicisation of our police forces through elected police commissioners. This is not wide of the Question. Will he respond to reports that Mr Kit Malthouse sought to interfere in the Metropolitan Police’s actions in investigating phone hacking? That is but one example of the risk to this new system, in which the police and crime panels are the only defence but the Government are not going to fund them properly.

Lord Henley:My Lords, I have made it quite clear that we are going to fund the panels properly. I am not going to respond to the specific allegation made by the noble Lord, but if necessary—if I think it appropriate—I will write to him. What I am making clear is that we think we are providing appropriate funding for the panels to do the job that was set out in the police Bill last year. We think that they can do that because their job is to look at what the PCCs are doing.

Lord Harris of Haringey:My Lords, the experience in London is that so far the only information to have emerged from the Mayor’s Office for Policing and Crime, which is a surrogate police and crime commissioner, is a series of listed decisions on the website. How on earth is a police and crime panel outside London going to get to grips with the detail underlying that and the issues determined by the police and crime commissioner, with money that is insufficient to employ more than one or two people in support of busy local authority councillors who will have many other roles in addition to that on the panel?

Lord Henley:My Lords, I think that the noble Lord misunderstands—dare I say it?—how local authorities work. Obviously, the funding will be available to provide for some staffing to assist that panel, but within that local authority there will be other officers doing other jobs who will also be able to assist in that role. That does not require the extra funding that he described. However much money the Government offered, no doubt he and others would say that it was inadequate. We made an announcement on how much it would be. Having reviewed it, we have since increased it. We think that it will be sufficient.

Sunday
Mar 11,2012

My excellent webmaster, Jon Worth, has written a blog post about his experiences earlier today with security on the Eurostar from Brussels.

He describes the pointless inconveniences that were introduced to plug the holes in an already leaky system.  The extra measures in place on his journey were presumably intended to plug the Lille loophole, described in the Telegraph today.  Yet the “solution” provided hardly seems cost-efficient or particularly effective.

The Sunday Telegraph explains the problem as follows:

“The loophole centres on the Schengen agreement signed between a number of European countries, including France and Belgium, which allows people to cross borders without passport checks.

The UK is not in the agreement can therefore check the passports of passengers travelling here.

As a result there are two gates for Eurostar trains in Brussels, one for those going to Lille, which does not have passport checks, and one for the UK, which does.

It means an individual could buy two tickets and then pass through the Lille gate but stay on the train to London without having their passport examined.”

Jon Worth describes the extra checks which took place on his train (no doubt as a result of this morning’s article in the Sunday Telegraph):

“Then today when the train called at Lille for more passengers to alight and board, we were told on the public address system in the train that there would be additional checks in the train between Lille and Calais. These checks were carried out by a team of 7 French rail police carrying guns and batons, but just checking tickets (and not passports). I asked the policeman who checked my ticket why he was doing so. “Parce-que c’est comme ça” (because that’s the way it is) he replied. I pushed him further, saying that of course I had to have a valid ticket, because how otherwise could I have actually got on the train? “C’est contre la fraude” (it’s against fraud) was the best I got out of him before he moved off.”

So that wouldn’t have prevented anyone with evil intent slipping into the UK.

However, today there was an additional check at St Pancras:

“Then upon arrival in St Pancras, not announced to passengers on the train, all passports and all tickets were being checked by UK Borders at the exit. Which – quite frankly – seems to render other checks superfluous. Why bother having a UK Border check in Brussels, and French police check in the train, if you’re then going to check in London too?”

Excellent –  apart from the extra costs of the unnecessary and ineffective security checks beforehand.

But what about the impact on passengers?  As Jon Worth points out:

“due to the small terminal exit and a few hundred people streaming off a train, the checks are not swift in London.”

This means at peak time there will either be terrible delays or – as happened with other border controls – the extra checks will be lifted.

The problem is potentially serious and it is amazing that the Home Office seems so relaxed about it.

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.
Wednesday
Feb 15,2012

One of the difficulties in combatting terrorism is maintaining public support and vigilance over time as the memories of atrocities on mainland Britain fade.  The recent conviction of nine men who plotted to bomb the London Stock Exchange and build a terrorist training camp is a reminder that the threat has not gone away.  However, the Metropolitan Police campaign, “It’s probably nothing, but…“, will help reinforce the message that public vigilance is going to be essential – particularly in the run-up to the Olympics.

As the Met says:

“Everyone who works, lives and visits London has a role to play in helping to counter the terrorist threat which remains real and serious.”

The four week campaign consists of a 40 second radio advert to be aired on Kiss FM, Capital, LBC and GOLD, and press advertisements in local publications and minority media titles. The activity will also be supported by a digital presence on Spotify, and in excess of 1.4 million leaflets being delivered to households across London.

The radio advert recognises that some people may be reluctant to report suspicious activity or behaviour, such as someone paying for a car in cash but not taking it for a test drive, because ‘Chances are, it’s probably nothing’.

But it goes on to encourage people to think ‘But what if it isn’t’?

Just one piece of information could be vital in helping disrupt terrorist planning and, in turn, save lives.

The press advert seeks to reassure Londoners that if they see or hear something that could be terrorist related, they should trust their instincts and call the confidential Anti-Terrorist Hotline.

 

Tuesday
Feb 14,2012

Here is my speech from tonight’s debate on NHS bureaucracy:

“My Lords, it is an enormous pleasure to follow the noble Lord, Lord Fowler. I was particularly taken with his support for the principle of ring-fenced funding, which I trust the Minister will take into account when, a little later, we come to consider local healthwatch organisations.

Earlier today, we had a Question on the initiatives that had been taken in London on stroke care. I did not get an opportunity to pose this question but I was interested in who, in the absence of NHS London driving the process, would have taken the quite difficult decision to reorganise stroke care in London, given that it was opposed by a lot of the local providers and local organisations. This question also came up during the first day on Report when we looked at who would make decisions on reconfiguring services and who would make decisions when services were not adequate or when there were issues of equality of healthcare to be addressed. At one point, the Minister said,

“The CCGs will be supported in their efforts to improve quality by the NHS Commissioning Board”.—[Official Report, 8/2/12; col. 314.]

Later on, when I probed him on this, he said that “the board”—that is, the NHS Commissioning Board—“will be represented sectorally”. I was not quite sure what he meant, but it being Report stage I could not challenge him. He said:

“There will be field forces in all parts of the country … The majority of its staff will be a field force”.—[Official Report, 8/2/12; col. 316.]

I do not know how a majority can be a field force, but there we are. Later on, he said:

“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”.

When I questioned whether that meant that they would be members, he said:

“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”.—[Official Report, 8/2/12; col. 340.]

I took that to mean that the NHS Commissioning Board will be sitting at the centre of the National Health Service with its tentacles going out to all parts of the health service. The Minister did not really like that. He said:

“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”.—[Official Report, 8/2/12; col. 352.]

If the noble Earl does not like the metaphor of tentacles reaching out across the health service, perhaps a better metaphor would be to see the NHS Commissioning Board as some sort of Spanish Inquisition, reaching out to the local clinical commissioning groups and to the health and well-being boards, saying, “We are here to help”, which is no doubt what the Spanish Inquisition said in its heyday, and, “We are a resource to promote guidance”, which is also what I suspect that the Spanish Inquisition might have said in its heyday. I have to ask whether what we have before us is really a less bureaucratic structure when it has this enormous inquisition-like structure sitting in the middle of it, promoting things at a local level.

We are replacing a fairly simple, basic idea: the Department of Health in the middle with a series of strategic health authorities and below those the PCTs. I believe that the previous Government should have done more to reduce the number of PCTs and I know that my noble friend Lord Warner worked very hard, in his various incarnations, to try to achieve just that. There are too many PCTs, but we did not need this Bill to reduce the number of PCTs. Nor did we need this Bill to give those PCTs clinical leadership. All that was required was to appoint local doctors, local clinicians, to lead those PCTs, and that could have been done from the Department of Health. You did not need this Bill to reduce bureaucracy and to simplify that fairly straightforward structure; you did not need this Bill to give clinical leadership; and you certainly did not need the top-down reorganisation, which I think we were promised we would not have.

Instead we shall have the Department of Health at the centre and the Secretary of State, who will not micromanage but who will have instead the NHS Commissioning Board. No doubt the Secretary of State, like some latter day Henry II will say, “Who will rid me of this rebellious CCG?”, or, “Who will require something to happen in a local provider?” and popping up like some—I am mixing my metaphors—Torquemada will be the chief executive of the NHS Commissioning Board, Sir David Nicholson, who will say, “Ah, right, this is something that we will take on; it is not something that you, Secretary of State, should be micromanaging yourself; we, the NHS Commissioning Board will micromanage it through our network of clustered strategic health authorities, through our commissioning support groups and through the 300 CCGs, not forgetting these wonderful bodies, the clinical senates”. No doubt this is my failure rather than anyone else’s, but I have yet to understand exactly how the clinical senates will operate. I rather suspect that they will be like the Deputy Prime Minister’s proposals for a replacement for your Lordships’ House: they will be costly, rather powerless and part of this panoply of structures.

Throughout all this, there will be the field forces of the NHS Commissioning Board, not reaching out like tentacles, but being there as a resource to promote guidance and to make things happen. Apparently from this Bill, which allegedly will reduce bureaucracy—this morning I heard a government apologist on the radio saying that the Bill is all about reducing bureaucracy—we will have this network of individuals who will work with, or even sit on, local health and well-being boards, working to encourage and promote guidance and advice and working with clinical commissioning groups. They will be individuals who will, largely, be anonymous, invisible and unaccountable, except upwards to the NHS Commissioning Board. I am not sure that I accept that this will be a less bureaucratic structure but I am quite sure that it will be a much less clear and accountable structure than anything we have had before.

Recently, I was in a meeting with a number of London MPs who were talking about how these new arrangements will work. The question they wanted answered—this is the Henry Kissinger question—was who do we phone to talk to when some issues takes place which is not soluble by an individual clinical commissioning group or is not simply an issue that relates to one provider? Where do we go? Presumably, we ought to go to this anonymous individual, anonymous representative of the NHS Commissioning Board. No one will know who that person is. That person will not be accountable and presumably will not be supposed to talk to Members of Parliament.

The question that I hope the noble Earl will answer about where the Bill is going—I accept the comments of the noble Lord, Lord Fowler, that it may not be perfectly drafted—is: how baroque will the structure be underneath the NHS Commissioning Board? How will that structure of individuals and field forces, which will manipulate what happens in local CCGs and in local health and well-being boards, work? How will a field force be held accountable, visibly and locally to the population who will be affected by the decisions of those influenced by that local field force?”

And here is Sir David Nicholson, Chief Executive of the NHS Commissioning Board:

david_nicholson020310.jpg

And, of course, he is nothing like Tomas de Torquemada, the Grand Inquisitor of the Spanish Inquisition:

Torquemada.jpg

But then nobody expected the Spanish Inquisition did they?

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.