NHS that involves and listens to local people is in all our interests

Cllr Ketan Sheth

Readers may be aware that the way in which the local NHS is run is likely to see big changes in the months ahead. Part of the NHS Long Term Plan is for local NHS bodies in each area to work in partnership with local councils as part of an ‘Integrated Care System’ (ICS). In North West London, this will mean a huge partnership across eight boroughs, including Brent – my Local borough. It may also mean a merger of the eight clinical commissioning groups (CCGs) across these areas into a single CCG for North West London (subject to a vote of GPs in each borough).

NHS leaders assure us that this is not a change to services, but to how their staff are organised. They say that any changes that are proposed under the new working arrangements will be subject to the same – or more – consultation and scrutiny. We need to hold them to this promise. The biggest concern for me, as a Brent councillor, is that the voice of Brent residents is not lost in a new system covering a huge geographical area (the North West London ICS and the single CCG would be the biggest in the country).

At a recent Joint Overview and Scrutiny Committee, we had the chance to question managers and GPs about the single CCG merger. There were certainly encouraging words about their future approach to involving local people in shaping health services. They have put in place a new programme, rather grandly called ‘EPIC’ (Engage, Participate, Involve, Collaborate), which they say is a direct response to the challenge of maintaining the voices of local residents in a much bigger system.

Working with local patient groups and Healthwatch organisations, they are co-producing an ‘Involvement Charter’ setting out how the public can get involved and setting standards we can hold them to. They have expressed a commitment to strengthening the current approach and involving more people, reaching deeper into our communities than ever before. They have promised to work with councillors and others to reach the most vulnerable and isolated people, who the NHS does not have a good track record of engaging. And alongside this ‘qualitative’ engagement, they have set up a 4,000-strong Citizens’ Panel, representative of local communities, allowing them to test public opinion through surveys and focus groups on a range of issues.

The programme is ambitious and no one could argue with its stated objectives. But as ever, the proof of the pudding is in the eating. The NHS is facing big challenges right now, not least in getting services up and running again in the wake of Covid-19. Getting public engagement right is going to be more important than ever. If this programme really does see a step change in how the local NHS works with our residents – and most importantly, if it acts on what people tell them – it will have my support. My message to NHS colleagues is simple: the goals you have set out are welcome, but we will need swift and tangible evidence that things are really changing for the better. The National Health Service that involves and listens to local people is in all our interests.

 

ketan

Cllr Ketan Sheth

Chair, Brent Council Community and Wellbeing Scrutiny Committee

Exploring corruption risks in local government planning decisions

Teddy Marks, Transparency International UK

Anyone who’s lived near or been involved in a major planning application knows they are a magnet for controversy and tension. This is exactly why the decision to grant or reject permission is given to local representatives – to ensure there is some form of accountability. Yet recent examples have shown how planning decisions can go wrong. Even without the existence of wrongdoing, the perceptions of impropriety can undermine millions, if not billions, of pounds of investment in new homes.

A new report from Transparency International UK, Permission Accomplished, sought to find out why these scandals have happened and how lessons can be learnt. To do this we began by reviewing 13 major cases where alleged or proven impropriety by councillors had affected planning decisions across England. From this, we identified three key areas of risk and how local authorities could mitigate them. Most of the proposals are based on existing recommendations from the Local Government Association (LGA) and the Committee on Standards and Public Life (CSPL).

To see how local authorities were applying these in practice, we looked at the policies and procedures of 50 councils (representing 15 per cent of English planning authorities) and scored them against our recommended good practice standards. To make sure we were being fair and consistent, we developed a scoring matrix from 100 (meets good practice) to 0 (poor), and invited councils to comment on their draft findings and methodology. We also subjected the results to robust internal review and a standardisation process to ensure we assessed all councils equally.

Worryingly, not one council scored higher than 55, and the average score was 38 out of 100. Clearly, local authorities have a lot of room for improvement.

So what are the main corruption risks facing councillors in planning decisions, and how have well have councils addressed them? I’ve provided some highlights below.

 

Councillors’ engaging external stakeholders

Putting forward one’s view is not in and of itself a bad thing, and is an important part of the planning process. But lobbying behind closed doors and providing excessive gifts and hospitality to decision makers are real red flags. At best, this can present the view of councillors in hock with wealthy developers. At worst, they can suggest complicity in criminal conduct.

Both Transparency International UK and the LGA propose local authorities require all meetings between councillors and developers (and their representatives) for major developments to be minuted and available for public inspection. Yet just 44 per cent of councils in our sample required this, and only 12 per cent explicitly stated that they be published. We also both recommend there should be an official present in these meetings, but only 30 per cent do this.

As for gifts and hospitality, councillors must be prohibited from accepting any that risk undermining the integrity of the planning process. Only 26 per cent in our sample had any such ban.

 

Managing conflicts of interest

Conflicts of interest occur where a holder of public office is confronted with choosing between the duties and demands of their position, and their private interests. Councillors are elected to serve the public, but some companies employ existing and former councillors to help them get planning consent. When councillors are employed to do so whilst still in public office, it can create a direct tension between their civic duties and private interests.

In a brief search, we found 72 existing councillors across 50 local authorities who are, or used to be, employed by companies working in the housing and/or planning industry whilst they were holding public office. Currently, 32 of these councillors across 24 councils hold critical decision-making positions; for example, as members of a planning committee.

Although some councils stopped councillors from acting as agents, not one had explicitly prohibited them from lobbying on behalf of paying clients or providing paid advice on how to influence councils.

 

Regulating councillors’ conduct

Weak oversight, especially when combined with poor codes of conduct and decisions with lots of money at stake, almost encourages misconduct. Yet local authorities do not have the legal right to suspend or disqualify councillors for serious breaches of the councils’ codes – a robust measure recommended by the Committee on Standards in Public Life (CSPL) and available to councils in other parts of the UK.

Additionally, while the majority of councils in our sample had proactive standards committees to provide oversight on councillors’ ethical conduct, 22 per cent of local authorities either had inactive standards committees or they didn’t have one at all.

 

Moving forward

Most councillors serve their communities with integrity, but our findings show that the existing system is open to the perception, and also the reality, of abuse. To mitigate these risks and strengthen democracy, we provide ten detailed recommendations in our report, which can be summarised into three key themes:

  • Increase transparency over councillors’ engagement with developers and their representatives to prevent the perception or reality of undue influence.
  • Tighten rules governing the conduct of councillors to protect the planning process from abuse for personal gain.
  • Strengthen oversight over councillors’ conduct to deter behaviour that would bring the integrity of the planning process into question.

 

 

Transparency International is the UK’s leading independent anti-corruption organisation:  https://www.transparency.org.uk/

Teddy Marks, Research Officer

Teddy joined the UK Anti-Corruption Programme in January 2020. His work focuses on corruption risks in planning and housing decisions both at the national and local level. Previously, Teddy interned at Transparency International’s Defence and Security Programme after gaining professional experience in political risk. He holds a Masters in International Relations at the LSE, and a Bachelors in Politics and Quantitative Research Methods at Bristol University.

 

 

 

 

 

Prime Minister, remember when you weren’t hell-bent on infantilising local government?

Chris Game

 

I should just have returned from Limpopo, northernmost South African province and home to a substantial chunk of the famous Kruger National Park.  I, however, would have been there not for the wildlife, or even the wild life, but for the eminently respectable annual conference of IASIA, the International Association of Schools and Institutes of Administration, of which I’ve been a participative, though non-officeholding, member for the past quarter-century.

And now, after opening two sentences with a first-person singular pronoun, I should issue a READER ALERT!  There is, I promise, a serious point underpinning this blog. The first part, though, will contain more of those F-PS pronouns than even my average blog – sorry, but you have been warned.

Coincidentally, my very first IASIA conference, in 1996, was also in South Africa – in Durban, in the newly created province of KwaZulu-Natal, shortly after its first, violence-delayed, post-apartheid municipal elections had finally taken place.  The conference and the whole visit constituted a huge learning experience – and one acquired almost fortuitously.

For, despite INLOGOV being almost a model of the kind of institution IASIA/IIAS seeks to embrace – “involving both public service and academe”, whose interests and activities “target the education and training of public administrators and managers” – it always seemed colleagues in the then Development Administration Group, now the International Development Department, were the more active participants.

Anyway, it certainly gave me insights, opportunities and contacts I would never otherwise have had. That first Durban conference, for example, led fairly directly, if years later, to my involvement in a research project for the South African Municipal Demarcation Board on the relationship between size of municipality and efficiency of service delivery in the ‘new’ South Africa.

More recently, an exceptionally successful and in its way historic Ramallah conference in the immediate aftermath of the Grenfell Tower tragedy led to a paper (and subsequent blog) on how the new generation of elected Palestinian women mayors might have responded rather more impressively than Kensington & Chelsea’s politicians had managed.

Appreciation expressed, indulgent paragraphs over – thanks for your patience.  One thing I’m not really sorry to have missed with the Limpopo cancellation would have been the almost limitless curiosity of delegates – most following UK politics from several thousand miles’ distance – about the antics of the man who, for many, is our still relatively new Prime Minister. It would have been wearing, but I’d have borne it valiantly, not least because those with decent memories might well recall when I too had had positive things to say about the two-term Mayor of London – an office generally presumed abroad to be more powerful and prestigious than it is here.

Johnson never made it easy. Many delegates, whether or not they knew anything of his chaotic public and personal life, could certainly recall the man celebrating Britain’s first London 2012 Olympic gold medal by limply waving a Union Flag while stuck embarrassingly on a zip-wire.

It could sometimes be a tough gig, therefore, trying to persuade a predominantly overseas academic audience that, as London Mayor, the man had a record of some genuine achievement, if not on the scale of his hugely more experienced predecessor, Ken Livingstone.  But I tried, always starting with the headline statistics of his very election: twice, with over a million votes, to a post no other Conservative politician has come near to winning.

Evaluating his policy accomplishments was tougher, but, thanks to eventually effective delegation, there were, alongside the self-serving vanity projects, several tick-worthy boxes.  London’s homicide rate did fall dramatically between 2008 and 2016, by even more than it did nationally.  More so-called ‘affordable’ homes were built than during Livingstone’s two terms – though, in London especially, that A word is always debatable.

London Underground usage increased significantly, though ticket office closures continued and, by the time his planned night service finally arrived, he had gone. And it was bye-bye to fare-dodger-friendly ‘bendy buses’, hello again to environmentally friendly, double-decker Routemasters, albeit it at huge cost and some passenger discomfort.

Then there were the ‘Boris Bikes’ – nowadays the posher-sounding Santander Cycles – which, while not operating at the promised zero taxpayer cost, now constitute, I believe, Europe’s largest cycle hire scheme.

And, of course, like Paris for Bergman and Bogart in ‘Casablanca’, Boris will always have those undeniably memorable 2012 Olympics – notwithstanding that the idea and groundwork were Livingstone’s, the cost wildly over budget, and the legacy still debatable.

Over the years, then, I’ve felt able to talk – reasonably dispassionately, I hope – with international delegates about these things. But the topic I’ve always most emphasised, particularly in conference papers, has been finance: using London as a kind of headline illustration of how devolved government in the UK generally is centrally over-controlled and under-funded, compared to many of their countries’ systems.

In this I was much helped, unwittingly, by the man himself, who, as Mayor, professed similar concerns. For in 2012/13 he established a London Finance Commission, chaired by LSE Professor and finance expert, Tony Travers, which swiftly produced a neatly entitled report – Raising the Capital – with some seriously radical content.

Impossible here to summarise satisfactorily, the Commission’s conclusions were that London’s growing and changing population placed increasingly acute pressure on local services, while its existing sub-national governments lacked the financial powers to provide effective solutions.

A few illustrative stats: under 7% of tax paid by London residents and businesses was redistributed directly by locally elected bodies; 74% of London’s funding came through central government grants – compared with Berlin’s 25%, Paris’s 17%, and Tokyo’s 8%.

Taxation powers were merely one important part of the required reform.  But the Commission recommended (p.11) that “the full suite of property taxes” – council tax, business rates, stamp duty land tax, capital gains property development tax – be devolved to London government (GLC and/or boroughs), which should have responsibility for setting tax rates, revaluation, banding and discounts.

There was plenty more in the same vein – freedom to impose modest tourism and environmental taxes, planning fees and charges, and so on. My concern here, though, is less the Commission than the CommissionER.

Ever the catchy phrasemaker, Johnson launched his report by referring to tax-enfeebled London as “an economic and political giant but a fiscal infant …”.  However, while it was obviously the London Mayor’s Commission, making London proposals, the Mayor himself seemed more ambitious.

So, come the 2013 Conservative Party Conference in Manchester, there he was, leading a cross-party campaign with the London Councils and Core Cities Groups, arguing that England was much too centralised and calling for a comparable suite of fiscal reforms for England’s largest cities. An “historic and significant move …a partial but practical answer to the conundrum of English devolution … good not just for the cities involved, but for the country at large” … etc. etc.

Of course, nothing much changed substantively. London could still be tagged a “fiscal infant”, as could our whole local government system.

What changed was the man and his career: his personal political ambitions, the gift of Brexit, and the Johnson/Cummings project of running apparently the most unaccountable, centralist government of our age, in which the biggest city councils are mere marginisable infants.  A conference paper title for Limpopo 2021 perhaps?

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Chris Game is an INLOGOV Associate, and Visiting Professor at Kwansei Gakuin University, Osaka, Japan.  He is joint-author (with Professor David Wilson) of the successive editions of Local Government in the United Kingdom, and a regular columnist for The Birmingham Post.

Social care reform – comprehensive is good, but comprehensible vital

Chris Game

Cllr Ketan Sheth’s recent blog on ‘Local Government and the NHS Integrated Care System’ was, as he explained, timely for him personally – as an elected London borough councillor about to take on a novel scrutiny role in a new ICS.

For us Midlands readers it was timely too, for reasons most easily conveyed by the King’s Fund’s recent highly colourful Map 1 of ICSs so far established – highly colourful, that is, for some parts of England, including Cllr Sheth’s London, but bleak grey for others, like the whole of the Midlands, with merely our at least slightly more localised Sustainability and Transformation Partnerships (STPs).

This blog is not directly about either STPs or ICSs, which have only a late walk-on role. It is, though, about the future of social care and local government’s involvement in, or marginalisation from, that future, and it opens with one of Boris Johnson’s first Prime Ministerial broken pledges, in his very first speech as PM, to “fix the crisis in social care once and for all with a clear plan we have prepared”.

The ‘clear prepared plan’ bit was obvious fiction, and confirmed as such in the Conservatives’ December election manifesto.  60 pages, nearly 1,000 days working on a promised but still undelivered Green Paper, and no sniff of a plan.  One un-costed pre-condition (p.23) – that nobody should have to sell their home to pay for care – and a slightly desperate hope to build cross-party consensus on reform.

But last week, just eight months on, jostling with daily lockdown bulletins and courtesy mainly of The Guardian newspaper, saw a sudden small flurry of tantalising leaks. First came Ministers’ “radical plans for everyone over 40 to contribute towards the cost of social care in later life” – paying more in tax or national insurance, or insuring themselves against “hefty care bills when they are older”.

Broadly resembling the German and Japanese funding systems, it is variously labelled a ‘comprehensive’ and ‘compulsory’ insurance model, both of which, to be effective, it surely has to be.

But an even bigger question, I suggest in the blog’s title, is surely whether it can become a comprehensible and comprehended model, and pretty quickly – because the evidence is that our collective understanding of even the existing system is worryingly low.

With coincidental but near-perfect timing, the New Statesman magazine recently commissioned a poll by Redfield & Wilton Strategies asking a sample of 2,000 GB adults about their awareness of how social care is currently funded and organised. Its findings, for a topic dominating news headlines for several months now, were concerning.

Fewer than one in eight felt they were “significantly aware”, under half even “moderately aware”, and nearly a quarter “not aware at all”. They were then asked which of (1) the NHS, (2) private operators, and (3) my local council, they thought were currently providing community care in their locality.  Being a GB-wide sample, there are no precisely right or wrong answers, and ‘providing’ makes it almost a trick question – which personally I’d have opposed phrasing in this way. Still, there are better and worse guesses.

“My local council”, chosen by 55%, is a decent pick – if, by providing, you mean paying for.  But not, for decades now, if you mean actual care home beds.  As Covid has tragically demonstrated, funding is nowadays effectively separated from extremely fragmented provision, with only some 3% of beds directly provided by councils and at least 80% in over 11,000 homes by for-profit private companies, local organisations and charities.

As for payment – roughly £600 per week here in the West Midlands – just over one-third of residents have their fees met by their local authority; one in eight pay top-up fees, but the biggest fraction must find the full fees themselves.  Which, given our apparently limited understanding of the present-day system, must frequently come as a serious shock.

Exactly half the poll respondents ticked the “private operators” option. However, virtually as many (48%) nominated the NHS, which, note the authors, is nowadays “a very small player” indeed in providing social care.  It’s not totally wrong, but close – and that, in the proverbial nutshell, is Ministers’ social care problem.

The public generally have low understanding of how even the present care home system works, of how literally dis-integrated it has become, with home care provision twice as fragmented and considerably more expensive. But they love, clap for, and think they know ‘their’ NHS.

It was even more starkly highlighted in the crunch question: “Which of three options for the future of social care comes closest to your own view?”  Exactly half the respondents selected the ‘NHS model’ that many had just demonstrated they seriously misperceived: “Social care should be free at the point of use, regardless of whether individuals contributed taxation into the system during their working lives”.

Just over one-third preferred the ‘pension’ or ‘compulsory insurance’ model referenced in the Guardian story – or, rather, first story.  For, the following day, it reported Government plans to in effect merge health and social care services, taking the latter away from local councils altogether and handing them and their £22.5 billion annual funding over to the NHS.

The Department of Health and Social Care issued a routine denial, but the PM’s long awaited ‘plan’ appears, currently, to be that care services would be commissioned by, and funded through, the new NHS regional Integrated Care Systems (ICSs) gradually unrolling across England – although not, as yet, the Midlands, where we’re still in the Sustainability and Transformation Partnership phase.

I conclude with what seems a bit of a personal dilemma. Having worked for over half my life for an ‘Institute of Local Government Studies’, I instinctively deprecate both the fact and implications of elected and accountable local authorities losing a major function for so long integral to their existence.

On the other hand, if that’s what most people reckon they want, and the Government fundamentally misunderstands, distrusts, and already wants to diminish and/or abolish local councils ….   The question is: would the public be prepared to pay the cost of NHS-style “social care, free at the point of use”, largely unaddressed in the New Statesman questionnaire?  But that’s for another blog.

 

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Chris Game is an INLOGOV Associate, and Visiting Professor at Kwansei Gakuin University, Osaka, Japan.  He is joint-author (with Professor David Wilson) of the successive editions of Local Government in the United Kingdom, and a regular columnist for The Birmingham Post.

Can democratic renewal help us ‘build back better’ from the COVID-19 crisis? Key recommendations from the Newham Democracy and Civic Participation Commission

Elke Loeffler and Nick Pearce

Newham has seen one of the highest rates of COVID 19 mortality in England and Wales. Being one of the 10% most deprived areas in the UK (according to 2019 deprivation indices) the crisis has exposed wider social and economic inequalities – in health, housing, access to services and income – particularly for the Black and Minority Ethnic population.

At the same time, Newham has also seen a flowering of community support and creativity in response to the crisis. The local council has pioneered new ways of working with the voluntary and community sector. A new COVID-19 Health Champions network has been launched to empower thousands of Newham residents to remain up to date on the latest advice about COVID-19, and a new digital initiative  ‘Newham Unlocked Community Broadcasts’ showcases the creativity of local artists.

Newham is also one of a relatively small number local councils in the UK which have a directly elected Mayor. In 2018 Rohksana Fiaz took over from Sir Robin Wales, after his 23 years in the post, as London’s first directly-elected female mayor. In her election manifesto Fiaz promised to hold a referendum on the direct elected mayoral system before the end of her third year as Mayor (i.e. 2021), although the impact of the COVID-19 pandemic will affect this timeline.

The Democracy and Civic Participation Commission

In this context the Mayor and the Council of Newham set up an independent Commission in autumn 2019 to examine both the Council’s current directly elected Mayor system of governance and the alternative approaches that exist in English local government, and to make recommendations on the best system of governance for Newham’s future, and to explore ways in which local residents can become more engaged and more fully involved in local decision-making and the Council’s work.

The Commission was led by Professor Nick Pearce. Extensive evidence gathering took place between November 2019 and February 2020.

A key concern of the six Commissioners was to make bold recommendations to reduce inequalities in public participation and bring citizen power into the Council to improve public services and the quality of life of local people. The COVID-19 crisis, which occurred during the latter stages of the Commission’s work, gave a dramatic glimpse of the huge potential resources in the community and the willingness of local people to make a contribution to improve the quality of life in their neighbourhood.

The “Newham Model” for more inclusive public participation

The resulting “Newham Model” aims to provide checks-and-balances to the way in which Newham is governed. It provides new participatory governance mechanisms. In particular, the Commission Report proposes the creation of a permanent Citizens’ Assembly, selected like a jury – the first of its kind in England. It suggests strengthening the accountability of the executive Mayor to local people and the main stakeholders of the Council, while also limiting the mandate of the executive Mayor to two terms, so that there is a frequent impulse for innovation and creative thinking at the centre of the Council.

Other key recommendations for strengthening public participation and co-production of public services and outcomes with local people are:

  • Extension of participatory budgeting – an increase in the resources allocated to areas or neighbourhoods for expenditure which is determined by local people from the current level of £25,000. The aim should be to spend a minimum of 20% of the Community Infrastructure Levy (CIL) resources through neighbourhood or area-based participation.
  • A new framework for area-based decision-making – allowing powers to be drawn down to the most local level – along with the piloting of an ‘urban parish council’ in one of Newham’s communities.
  • A new “Mayor’s Office for Data, Discovery and Democracy” to provide expertise and leadership on the democratic use of data, digital tools for resident engagement, and learning from digital champions such as the government of Taiwan.
  • Wider use of co-production with residents and people accessing services, including area regeneration, which means that the local council needs to become much better at mapping what local people are doing, and want to do in the future.
  • Enabling local councillors to play the increasingly important role of ‘community connectors’, mobilising local people and their enthusiasms.
  • Support for an independent, community-owned local media organisation.

The Report of the Commission was launched on 6 July 2020 in a virtual public meeting, with presentations from the Commissioners, followed by responses by the Mayor and Vice-Mayor on behalf of the Council. Newham Council’s cabinet members will formally consider the commission’s report and recommendations at a later meeting.

Clearly, councils need to adapt the ‘Newham Model’ to fit their local circumstances, while simultaneously learning from democratic innovators in the UK and internationally.  Moreover, research institutions such as INLOGOV have an important role in sharing learning on new local governance models to help local government to ‘build back better’ from the COVID-19 crisis.

 

Nick Pearce is Director of The Institute for Policy Research (IPR) and Professor of Public Policy at the University of Bath. He was formerly director of the Institute for Public Policy Research (IPPR), as well as Head of the No 10 Downing St. Policy Unit between 2008 and 2010.

Elke Loeffler is a Senior Lecturer at Strathclyde University, and INLOGOV Associate. She is author of ‘Co-Production of Public Services and Outcomes’ and co-editor of ‘Palgrave Handbook of Co-Production of Public Services and Outcomes’, both of which will be published in autumn 2020.

Local Government and the NHS Integrated Care System

Cllr Ketan Sheth

For those councillors in local government who scrutinise the NHS, it seems to have become an expectation that as one great change ends in our local health services, another begins.

A good few years ago in north-west London we saw the start of the Sustainability and Transformation Plans (later rebranded as Sustainability and Transformation Partnerships) or STPs as they were widely called. Now it seems another change is on the way. By April 2021 an Integrated Care System (ICS) will have been introduced, taking forward much of what was developed by the STPs. And, they are coming at a time of incredible change for the NHS and local government as a result of dealing with the Covid-19 pandemic.

I’m sure many of you are familiar with an ICS. If I had to summarise, I would say they are in essence bringing together health providers and commissioners, along with local government, to plan healthcare based on local population health needs in a defined geographical area. I’ve noticed the term ‘place’ features frequently in the NHS documentation and published reports. I should say as well, that the underpinning and thinking for them is all set out in the NHS Long Term Plan. In a few areas such as Greater Manchester, they started in 2018, and more have been set up to the point where around half of England’s population is now covered by an ICS.

As for my local proposed ICS, this will be cover around 2.3million residents across eight London boroughs in north-west London stretching from Westminster out to Hillingdon, with multiple providers, and community healthcare Trusts as well, and not to forget, the local authorities. At the moment, each borough has its own clinical commissioning group (CCG), but the plan is for one CCG to cover the whole area as well (but that development is best discussed at another time) across the eight boroughs.

So, what I want to address here is this – how does an elected member sitting on an overview and scrutiny start to grips with effectively reviewing and holding to account the development of a ‘system’ of such complexity, and in the constraints of the time and resources we all know elected members face? What should our starting principles be? It’s not easy to answer, but I have a few suggestions.

As an elected member, I don’t necessarily need to worry about being a ‘systems thinker’ but I do like to test the local ICS thinking constructively. I would perhaps ask this – thinking about the ordinary residents in my ward what will it deliver for them? What will an ICS do to make them and their families and children healthier, and be able to live longer and with a better quality of life? Ultimately, for me that’s what organisational systems in our public services should be about. Simply, a means to an end of delivering something better for ordinary people and our communities.

Also, while we talk about ‘systems’ in health services, let’s not forget that when we refer to hospitals in particular we are talking often about important local institutions which command a lot of local pride and attachment; not just because of the services they provide, but because of the outstanding research they do. Also, in my home borough of Brent, they are important local employers. I think this way of looking at the world from the grassroots should not be lost in these changes.

So that’s a few ways we can start to get to grips with such a big change, and complexity. Then it might be time to prepare for the next one, whatever that may be.

 

ketan

Cllr Ketan Sheth

Chair, Brent Council Community and Wellbeing Scrutiny Committee